Vaccination Programs: Provider Education When Used Alone
Summary of CPSTF Finding
CPSTF Finding and Rationale Statement
About The Systematic Review
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
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
- 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?
- Included studies were conducted in hospitals and primary care settings.
- Studies focused on uptake of different vaccinations including pneumococcal, influenza and the childhood series.
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
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.
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
- Immunization Programs
Considerations for Implementation
- Provider education can be included in two multicomponent interventions approaches recommended by the CPSTF: