Interventions to Improve Influenza and Pneumococcal Vaccination Rates Among Community-Dwelling Adults: A Systematic Review and Meta-Analysis

Abstract

PURPOSE Infl uenza and pneumococcal vaccination rates remain below national targets. We systematically reviewed the effectiveness of quality improvement interventions for increasing the rates of infl uenza and pneumococcal vaccinations among community-dwelling adults. METHODSWe included randomized and nonrandomized studies with a concurrent control group. We estimated pooled odds ratios using random effects models, and used the Downs and Black tool to assess the quality of included studies. RESULTSMost studies involved elderly primary care patients. Interventions were associated with improvements in the rates of any vaccination (111 comparisons in 77 studies, pooled odds ratio [OR] = 1.61, 95% CI, 1.49-1.75), and infl uenza (93 comparisons, 65 studies, OR = 1.46, 95% CI, 1.35-1.57) and pneumococcal (58 comparisons, 35 studies, OR = 2.01, 95% CI, 1.72-2.3) vaccinations. Interventions that appeared effective were patient fi nancial incentives (infl uenza only), audit and feedback (infl uenza only), clinician reminders, clinician fi nancial incentives (infl uenza only), team change, patient outreach, delivery site changes (infl uenza only), clinician education (pneumococcus only), and case management (pneumococcus only). Patient outreach was more effective if personal contact was involved. Team changes were more effective where nurses administered infl uenza vaccinations independently. Heterogeneity in some pooled odds ratios was high, however, and funnel plots showed signs of potential publication bias. Study quality varied but was not associated with outcomes.CONCLUSIONS Quality improvement interventions, especially those that assign vaccination responsibilities to nonphysician personnel or that activate patients through personal contact, can modestly improve vaccination rates in communitydwelling adults. To meet national policy targets, more-potent interventions should be developed and evaluated. INTRODUCTIONI nfl uenza and pneumococcal disease are vaccine-preventable causes of morbidity and mortality. [1][2][3] Clinical practice guidelines have recommended routine infl uenza and pneumococcal vaccinations for elderly and nonelderly high-risk patients. [4][5][6] More recently, infl uenza vaccinations have been recommended for all individuals older than 6 months. 7 Even so, vaccination rates remain low. 8,9 Studies of interventions for improving adult infl uenza and pneumococcal vaccination rates are numerous and have been synthesized in several systematic reviews. Jacobson and Szilagyi found that patient reminder and recall systems improved vaccination rates. 10 The US Preventive Services 14 Most recently, Thomas et al found evidence of moderate quality that increasing community demand, vaccinating seniors during home visits, and deploying prevention facilitators working with health professionals improved infl uenza vaccination rates.15 Though important, these reviews have a variety of limitations. For example, Thomas et al included randomized controlled trials, most of which were graded low in quality. ...

UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study

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Publicly funded remuneration for the administration of injections by pharmacists

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