Vaccination Programs: Provider Education When Used Alone

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine if provider education interventions used alone improve vaccination rates.

Intervention

Provider education used alone aims to increase providers’ knowledge and change their attitudes about vaccinations. Information may be shared through written materials, videos, lectures, continuing medical education programs, computer-assisted instruction, or distance-based training.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2010 (5 studies with 6 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012).

This review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to increasing appropriate vaccination. The finding updates and replaces the 2010 finding for Provider Education When Used Alone.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included six studies with seven study arms.

  • Overall vaccination rates increased by a median of 4 percentage points (6 studies with 7 study arms).
    • None of the individual estimates were statistically significant and results were inconsistent across studies.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)
  • How effective is provider education when used to promote new vaccines or expanded recommendations for specific vaccinations?
  • Are interventions effective when delivered through distance-based training or other, newer approaches?

Study Characteristics

  • Included studies were conducted in hospitals and primary care settings.
  • Studies focused on uptake of different vaccinations including pneumococcal, influenza and the childhood series.

Analytic Framework

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Boom JA, Nelson CS, Kohrt AE, Kozinetz CA. Utilizing peer academic detailing to improve childhood immunization coverage levels. Health Promot Pract 2010 May;11(3):377-86. doi: 10.1177/1524839908321487.

Cowan JA, Heckerling PS, Parker JB. Effect of a fact sheet reminder on performance of the periodic health examination: a randomized controlled trial. Am J Prev Med 1992;8:104 9.

Crouse BJ, Nichol K, Peterson DC, Grimm MB. Hospital-based strategies for improving influenza vaccination rates. J Fam Pract 1994;38:258 61.

Frazini L, Boom J, Nelson C. Cost-effectiveness analysis of a practice-based immunization. Ambulatory Pediatrics 2007; 7:167-175.

Siriwardena AN, Rashid A, Johnson MR, Dewey ME. Cluster randomised controlled trial of an educational outreach visit to improve influenza and pneumococcal immunisation rates in primary care. British Journal of General Practice 2002;52:735-40.

Taylor JA, Rietberg K, Greenfield L, et al. Effectiveness of a physician peer educator in improving the quality of immunization services for young children in primary care practices. Vaccine 2008;26(33):4256-61.

Search Strategies

Effectiveness Review

The CPSTF findings are based on studies included in the original review (search period 1980-1997) combined with studies identified in the updated search (search period 1997- February 2012). Reference lists of articles reviewed as well as lists in review articles were also searched, and members of our coordination team were consulted for additional references.

Details of the original search (1980-1997)

The following five electronic databases were searched during the original review period of 1980 up to 1997: MEDLINE, Embase, Psychlit, CAB Health, and Sociological Abstracts. The team also reviewed reference lists in articles and consulted with immunization experts. To be included in the review, a study had to:

  • have a publication date of 1980 1997;
  • address universally recommended adult, adolescent, or childhood vaccinations;
  • be a primary study rather than, for example, a guideline or review;
  • take place in an industrialized country or countries;
  • be written in English;
  • meet the evidence review and Guide chapter development team’s definition of the interventions; provide information on one or more outcomes related to the analytic frameworks; and
  • compare a group of persons who had been exposed to the intervention with a group who had not been exposed or who had been less exposed. In addition, we excluded studies with least suitable designs for two interventions (provider reminder/recall and client reminder/recall) where the literature was most extensive.
Details of the update search (1997- February 2012)

The team conducted a broad literature search to identify studies assessing the effectiveness of Vaccine Preventable Disease interventions in improving vaccination rates. The following nine databases were searched during the period of 1997 up to February 2012: CABI, CINAHL, The Cochrane Library, EMBASE, ERIC, MEDLINE, PSYCHINFO, Soci Abs and WOS. Reference lists of articles reviewed as well as lists in review articles were also searched, and subject matter experts consulted for additional references. To be included in the updated review, a study had to:

  • have a publication date of 1997- February 2012;
  • evaluate vaccinations with universal recommendations;
  • meet the evidence review and Guide chapter development team’s definition of the interventions;
  • be a primary research study with one or more outcomes related to the analytic frameworks;
  • take place in an high income country or countries;
  • be written in English
  • compare a group of persons who had been exposed to the intervention with a group who had not been exposed or who had been less exposed. In addition, we excluded studies with least suitable designs for two interventions (provider reminder/recall and client reminder/recall) where the literature was most extensive
Search Terms
  1. Immunization
  2. Vaccination
  3. Immunization Programs

Considerations for Implementation

Despite the finding of insufficient evidence, the following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

Crosswalks

Evidence-Based Cancer Control Programs (EBCCP)

Find programs from the EBCCP website that align with this systematic review. (What is EBCCP?)