Vaccination Programs: Provider Reminders

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends provider reminders when used alone or when combined with additional interventions to increase vaccination rates among people of all ages from different populations or settings.

The full CPSTF Finding and Rationale Statement and supporting documents for Vaccination Programs: Provider Reminders are available in The Community Guide Collection on CDC Stacks.

Intervention

Provider reminders let healthcare providers know when clients are due for specific vaccinations. Reminders are delivered in various ways including notes posted in client charts, alerts in electronic medical records, or letters sent by mail or e-mail. They may be handled separately or included in standard checklists or flowcharts.

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997-2007) combined with more recent evidence (5 studies, search period 2007-February 2012).

Study Characteristics

  • Conducted in a wide range of clinical vaccination settings including private practices, community health centers, ambulatory care clinics, and hospitals
  • Focused on uptake of different vaccinations including tetanus for adults and the childhood series

Summary of Results

Twenty-eight studies were included.

  • Overall vaccination rates increased by a median of 10 percentage points (22 studies)
    • Provider reminders used alone: median increase of 12 percentage points (7 studies)
    • Provider reminders used with additional interventions: median increase of 9 percentage points (15 studies)
  • Of six studies that did not provide common measure, five reported favorable results

Summary of Economic Evidence

Four studies were included (search period 1980-2012). Monetary values in 2013 U.S. dollars.

  • Median intervention cost: $7 per person per year (3 studies)
  • Median cost per additional vaccinated person: $309 (3 studies)
  • Cost tended to be higher for interventions using manual process instead of immunization information system
  • Median intervention group size: 2,910 clients (4 studies)
  • Three studies from U.S., one from Canada
  • Studies examined influenza or pneumococcal (2 studies), tetanus (1), and childhood series (1)

Applicability

Findings applicable to people of all ages from various populations and in a wide range of clinical settings.

Evidence Gaps

  • What are effectiveness, cost-effectiveness, and utility of system-level implementation of provider reminder interventions including regional or state-level immunization information systems (IIS)?
  • What are the strategies encourage regular and sustained use of reminder systems?
  • How effective are these interventions for adolescent populations?
  • What is the effectiveness of provider reminders in communities with disparities in vaccination rates?

Implementation Considerations and Resources

A subset of included studies suggests that standing orders may be more effective than provider reminder systems in improving vaccination rates in both inpatient and outpatient settings.

Crosswalks