Vaccination Programs: Client-Held Paper Immunization Records

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 systematic review included 8 studies with 11 study arms.

• Overall vaccination rates increased by a median of 5.3 percentage points (6 studies with 9 study arms).

• How effective are activities aimed at increasing the retention and use of client-held paper immunization records for children by their parents or other caregivers?
• What is the impact of electronic health records or immunization information systems on intervention effectiveness?

• Included studies used client-held paper immunization records as part of multicomponent efforts. Comparison groups received one or more interventions.

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.

Effectiveness Review

Summary Evidence Table – Effectiveness Review

Effectiveness Review

Dickey LL, Petitti D. Patient-held minirecord to promote adult preventive care. J Fam Pract 1992;34:457 63.

Dietrich AJ, Duhamel M. Improving geriatric preventive care through a patient-held checklist. Fam Med 1989;21:195 8.

McElligot JT, Darden PM. Are patient-held vaccination records associated with improved vaccination coverage rates? Pediatrics 2010; 125 (3): e467 72.

O’Sullivan AL, Jacobsen BS. Randomized trial of a health care program for first-time adolescent mothers and their infants. Nurs Res 1992;41: 210 5.

Stevens-Simon C, Kelly L, Brayden RM. A health passport for adolescent parents and their children. Clin Pediatr 2001;40(3):169 72.

Thomas P, Joseph TL, Menzies RI. Evaluation of a targeted immunisation program for Aboriginal and Torres Strait Islander infants in an urban setting. NSW Public Health Bull 2008;19(5-6):96 9.

Turner RC, Waivers LE, O’Brien K. Effect of patient-carried reminder cards on the performance of health maintenance measures. Arch Intern Med 1990;150:645 7.

Turner RC, Peden JG Jr, O’Brien K. Patient-carried card prompts vs computer-generated prompts to remind private practice physicians to perform health maintenance measures. Arch Intern Med 1994;154(17);1957 60.

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

• Paper immunization records may be useful when they are used consistently when providers update them and parents keep track of them.
• Children are more likely to receive recommended vaccinations and avoid being over-vaccinated. This is especially true when children are seen in nontraditional immunization settings, such as emergency departments.
• Barriers to use identified in the included studies and broader literature include the following:
  • Clients’ declining interest over time and low card retention.
  • Healthcare providers’ concerns about time management when using a preventive services checklist.
• Client-held paper immunization records will continue to be useful until issues of privacy, security, and quality of electronic records have been resolved.
• Paper records will continue to be useful for clients on the other side of the “digital divide.” This may be particularly true for some populations, such as clients with limited computer access and adults whose change in employment status is accompanied by a change in providers.
• Included studies reported that client-held records used for vaccination and other health purposes increased clients’ receipt of some preventative services.
• In settings where other records of immunization history are not readily available, such as emergency rooms, client-held paper immunization records may reduce administration of unnecessary vaccinations, associated costs, and clients’ discomfort.
• No harms of client-held paper immunization records were identified.