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Meta-Analysis
. 2021 Jul 28;38(4):524-536.
doi: 10.1093/fampra/cmaa149.

Interventions on health care providers to improve seasonal influenza vaccination rates among patients: a systematic review and meta-analysis of the evidence since 2000

George N Okoli  1 , Viraj K Reddy  1 , Otto L T Lam  1 , Tiba Abdulwahid  1 , Nicole Askin  2 , Edward Thommes  3 , Ayman Chit  3 , Ahmed M Abou-Setta  1   4 , Salaheddin M Mahmud  4   5
Affiliations
Meta-Analysis

Interventions on health care providers to improve seasonal influenza vaccination rates among patients: a systematic review and meta-analysis of the evidence since 2000

George N Okoli et al. Fam Pract. .

Abstract

Background: Seasonal influenza vaccination (SIV) rates remain suboptimal in many populations, even in those with universal SIV.

Objective: To summarize the evidence on interventions on health care providers (physicians/nurses/pharmacists) to increase SIV rates.

Methods: We systematically searched/selected full-text English publications from January 2000 to July 2019 (PROSPERO-CRD42019147199). Our outcome was the difference in SIV rates between patients in intervention and non-intervention groups. We calculated pooled difference using an inverse variance, random-effects model.

Results: We included 39 studies from 8370 retrieved citations. Compared with no intervention, team-based training/education of physicians significantly increased SIV rates in adult patients: 20.1% [7.5-32.7%; I2 = 0%; two randomized controlled trials (RCTs)] and 13.4% [8.6-18.1%; I2 = 0%; two non-randomized intervention studies (NRS)]. A smaller increase was observed in paediatric patients: 7% (0.1-14%; I2 = 0%; two NRS), and in adult patients with team-based training/education of physicians and nurses together: 0.9% (0.2-1.5%; I2 = 30.6%; four NRS). One-off provision of guidelines/information to physicians, and to both physicians and nurses, increased SIV rates in adult patients: 23.8% (15.7-31.8%; I2 = 45.8%; three NRS) and paediatric patients: 24% (8.1-39.9%; I2 = 0%; two NRS), respectively. Use of reminders (prompts) by physicians and nurses slightly increased SIV rates in paediatric patients: 2.3% (0.5-4.2%; I2 = 0%; two RCTs). A larger increase was observed in adult patients: 18.5% (14.8-22.1%; I2 = 0%; two NRS). Evidence from both RCTs and NRS showed significant increases in SIV rates with varied combinations of interventions.

Conclusions: Limited evidence suggests various forms of physicians' and nurses' education and use of reminders may be effective for increasing SIV rates among patients.

Keywords: Health personnel; human influenza; intervention; meta-analysis; systematic review; vaccination.

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Figures

Figure 1.
Figure 1.
Summary of literature search and screening process (modified PRISMA flow chart).
Figure 2.
Figure 2.
Forest plot of team-based training/education of physicians compared with no intervention, in adult patients (RCTs).
Figure 3.
Figure 3.
Forest plot of reminders (prompts) compared with no intervention (RCTs).
Figure 4.
Figure 4.
Forest plot of combined team-based training/education of physicians and nurses, and reminders (prompts) compared with no intervention, in adult patients (RCTs).
See this image and copyright information in PMC

References

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    1. European Centre for Disease Prevention and Control. Seasonal Influenza Vaccination and Antiviral Use in EU/EEA Member States: Overview of Vaccine Recommendations for 2017–2018 and Vaccination Coverage Rates for 2015–2016 and 2016–2017 Influenza Seasons. Stockholm, Sweden: ECDC, 2018.
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    1. National Advisory Committee on Immunization (NACI). Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2017–2018. Ottawa, Ontario, Canada: Public Health Agency of Canada, 2017.
    1. Ortiz JR, Perut M, Dumolard Let al. . A global review of national influenza immunization policies: analysis of the 2014 WHO/UNICEF Joint Reporting Form on immunization. Vaccine 2016; 34(45): 5400–5. - PMC - PubMed

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