Table 1 Characteristics of the included studies
HCPs | Patients | ||||||
|---|---|---|---|---|---|---|---|
Study | Intervention | Control | Intervention | Control | Targeted population | Intervention type(s) | Main outcome(s) |
Calkins, Katz [20] | 17 primary care providers (5 practices) | 19 primary care physicians (4 practices) | 45 | 45 | 65+ | Small-group consensus process | Vaccination rates |
Chambers, Balaban [21] | Physicians (n = 32) were stratified by level of training and randomized to one of three groups, | See under ‘Intervention’ | -Always reminded: 271 -Sometimes reminded: 146 | -Never reminded: 218 | 65 + or risk groups | Reminder (digital) | Vaccination rates |
Chan, MacLehose and Houck [44] | -Solo practices 1997: 23 -Group practices 1997: 28 -Solo practices 1998: 20 -Group practices 1998: 32 | -Solo practices 1997: 21 -Group practices 1997: 33 -Solo practices 1998: 20 -Group practices 1998: 27 | -Solo practices 1997: 1486 -Group practices 1997: 1341 -Solo practices 1998: 561 -Group practices 1998: 868 | -Solo practices 1997: 596 -Group practices 1997: 877 -Solo practices 1998: 1310 -Group practices 1998: 1286 | Patients with a chronic medical condition | Reminder (paper) | Vaccination rates |
Changolkar, Rewley [60] | Low clin. workload: 12 physicians High clin. workload: 18 physicians | Low clin. workload: 3 physicians High clin. workload: 23 physicians | Low clin. workload: before:1974 (pre-intervention), 1799 (post) High clin. workload: 6397 (pre-intervention), 5342 (post) | Low clin. workload:558 (pre-intervention), 516 (post) High clin. workload:14,275 (pre-intervention), 14,549 (post) | Mean age (SD): 58.7 (16.3) years | Reminder | Vaccination rates |
Cohen, Littenberg [22] | 22 physicians (2 firms) | 1 firm (no info on number of physicians) | Eligible patients -Pneumovax: 547 -Influenza: 581 | Eligible patients -Pneumovax: 291 -Influenza: 291 | 65+ | Education + reminder (checklist, paper) | -Vaccination rates -Knowledge |
Cowan, Heckerling and Parker [23] | 16 residents | 13 residents | 62 | 45 | > 65 influenza and pneumococcal. Tdap every ten years | Reminder (recommend-dations, paper) | -Vaccination coverage -Knowledge -Attitude |
Crouse, Nichol [24] | 6 hospitals in total; 2 hospitals per intervention type | n/a | -Standing order group: 609 -Physician reminder group: 1925 Physician education group: 11,800 | n/a | High-risk patients | Comparison of: -standing orders -physician education -Physician reminder (paper) | -Proportion of offered vaccination -Vaccination rates |
Desai, Lu [61] | 14 rheumatologists | 21 rheumatologists | 3267 | 450 | -65 years and older - <64 when in immunocompromising condition/immunosuppressive therapy | Reminder (paper) | Vaccination rates |
Dexter, Perkins [45] | -96 (47.5%) physicians intervention group only -28 (13.9%) physicians assigned alternately to both intervention and control group | - 78 (38.6%) physicians control group only | 4995 hospitalizations | 5070 hospitalizations | NI | Reminder (digital) | Proportion of offered vaccination |
Dexter, Perkins [46] | 4 teams assigned to physician reminder group | 4 teams assigned to standing order group | 691 Patients eligible for vaccination | 623 Patients eligible for vaccination | − 65 years and older or risk group (relevant chronic disease) | Comparison of: - Standing orders (digital) -Physician Reminders (digital) | Vaccination rates |
Dubey, Mathew [47] | 20 primary care physicians | 18 primary care physicians | 248 | 261 | Patients aged 21 years and older | Reminder (paper) | Proportion of offered vaccination |
Flanagan, Doebbeling [25] | 70 physicians | 47 physicians | NI | NI | -Influenza: hospital employee or older than 64.5 years of age -Pneumococcal: recommended if age was greater than 64 years (flagged “consider” if more than 63.5 years) and more than 10 years since last received (flagged “consider” if more than 7 years since last received). -Td: recommended if no history of Tetanus vaccine in over 9 years and 6 months. | Reminder (digital) | Proportion of vaccines ordered |
Hohmann, Hastings [62] | 30 community pharmacies | 32 control community pharmacies | NI | NI | Unclear | Comparison of: -Multicomponent intervention -Online webinar | -Vaccination coverage -Organization level |
Hutchison [70] | NI | NI | Eligible patients: 593 | Eligible patients: 618 | 65 years and older | Reminder (paper) | -Vaccination rates -Patient refusal rate |
Jans, Schellevis [48] | 14 practices (total 16 physicians) | 5 practices (totalling 5 physicians) | 455 | 152 | 16–70 years of age and having received a diagnosis of asthma or COPD | Multicomponent intervention: quality system | Vaccination rates |
Karuza, Calkins [26] | 23 primary care physicians | 28 primary care physicians | Mean number of charts reviewed per physician: 30 | Mean number of charts reviewed per physician: 29 | 65 years and older | Small-group consensus process | -Vaccination rates -Attitude -Knowledge |
Kerse, Flicker [27] | 21 general practitioners | 21 general practitioners | 121 | 112 | 65 years and older | Multicomponent intervention: -Clinical practice audit with feedback -Educational detailing -Card based prompt system -Seminar or home based learning -Resource directory | -Vaccination rates |
Kiefe, Allison [49] | 35 physicians | 35 physicians | 965 | 966 | 65 years and older with diabetes mellitus | Comparison of: -multi-component intervention with performance feedback -Same multicomponent intervention + achievable benchmark feedback | -Vaccination rates |
Kim, Kristopaitis [28] | Multicomponent intervention: 21 primary care physicians | Education only: 20 primary care physicians | Multicomponent intervention: 905 | Education only: 905 | Patients aged 65 to 75 years | Comparison of: -Education only -Multicomponent intervention | -Proportion of vaccines offered -Vaccination rates |
Klein and Adachi [29] | NI | NI | 100 | 100 | -Patients of 65 years or older -Patients with high-risk conditions | Reminder (paper) | Vaccination rates |
Korn, Schlossberg and Rich [30] | 15 residents | 13 residents | -SPR site post-intervention: 199 -VA site: 149 | -SPR site pre-intervention: 202 -VA site: 151 | 65 years and older | Multicomponent intervention | Proportion of vaccines ordered |
Lemelin, Hogg and Baskerville [50] | 22 practices | 23 practices | NI | NI | 65 years and older | Multicomponent intervention | Vaccination rates |
Loo, Davis [62] | -Reminder: 17 primary care physicians -Reminder + panel manager: 17 primary care physicians | Control: 20 primary care physicians | -Reminder: 1336 -Reminder + panel manager: 1394 | Control: 1930 | 65 years and older | Comparison of -Reminder (digital) -Reminder (digital) + panel manager -Control | Vaccination rates |
Loskutova, Smail [64] | 23 primary care physicians | 20 primary care physicians | -Influenza year 1 (before): 20,952 -Influenza year 2 (after): 24,506 -Pneumococcal year 1 (before): 18,244 -Pneumococcal year 2 (after): 27,415 -Zoster year 2 (before): 27,415 -Zoster year 3 (after): 30,844 | -Influenza year 1 (before): 15,076 -Influenza year 2 (after): 17,256 -Pneumococcal year 1 (before): 12,577 -Pneumococcal year 2 (after): 21,465 -Zoster year 2 (before): 21,465 -Zoster year 3 (after): 24,906 | Influenza: 18 years and older Pneumococcal: -65 years and older -19-64 years when at least one risk factor Herpes zoster: 60 years and older | Comparison of: -Multicomponent intervention - Reminders + Clinical decision support system (algorithms for provider reminders and standing orders) | Vaccination rates |
MacIntyre, Kainer and Brown [51] | NI | NI | Hospital reminder: 70 GP reminder: 61 | n/a | 65 years and older | Comparison of: -Hospital reminder (paper + verbal) -GP reminder (letter) | Vaccination rates |
McDonald, Hui [31] | 61 residents | 54 residents | NI | NI | Influenza: according to U.S. Public health service criteria Pneumococcal: Over 65 years, otherwise according to U.S. Public health service criteria | Reminder (paper) | -Intentions among HCWs -Proportion of vaccines offered |
McDonald, Hui and Tierney [32] | NI | NI | -Intervention group 1978–1979: 1328 -Intervention group 1979–1980: 1489 -Intervention group 1980–1981: 1316 | -Control group 1978–1979: 1290 -Control group 1979–1980: 1412 -Control group 1980–1981: 1236 | Older than 65 years or risk group (chronic lung disease, asthma, diabetes mellitus, congestive heart failure, severe renal/hepatic failure) | Reminder (digital) | -Vaccination coverage -Disease incidence |
McGreevy, McGowan [65] | 2 attending physicians and 8 residents | Not explicitly stated | ≥ 65 years: 95 ≤ 65 years: 255 | ≥ 65 years: 103 ≤ 65 years: 242 | 65 years and older | Multicomponent | Vaccination rates |
Ngamruengphong, Horsley-Silva [66] | 20 primary care residents | 19 primary care residents | 29 | 17 | Patients with diabetes mellitus | Comparison of: -Standard education + extra 30-minute lecture + pocket card + monthly e-mail reminders with the lecture content -Standard education | Knowledge |
Nowalk, Nutini [67] | 10 providers and 7 clinical assistants | 2 providers and 3 clinical assistants | 7794 | 2199 | Influenza: all adults Pneumococcal: 65 years and older or high-risk patients aged 18–64. | Multicomponent: Toolkit | Vaccination coverage |
Ornstein, Garr [33] | -Physician reminders: 14 -Patient reminders: 12 -Physician and patient reminders: 13 | Control: 10 | -Physician reminders: 1988 -Patient reminders: 1925 -Physician and patient reminders: 1908 | Control: 1576 | 18 years or older | Comparison of: -Educational + administrative interventions -abovementioned interventions + reminders (paper) | Vaccination coverage |
Overhage, Tierney and McDonald [34] | 12 teams of physicians and medical students | 12 teams of physicians and medical students | 821 | 801 | Older than 65 years or in risk group (reactive airway disease, congestive heart failure, diabetes, splenectomy, sickle cell disease) | Reminder (digital and paper) | Compliance with preventive care guidelines |
Quinley and Shih [52] | -African-American practices: 118 -High volume practices: 582 | -African-American practices: 100 -High volume practices: 150 | NI | NI | 65 years and older | Comparison of: -Mailer only -Mailer + telephone follow-up | Vaccination rates |
Rosser, McDowell and Newell [36] | 6 teams consisting of a staff physician, nurse, and three to five residents. No information was provided on the distribution of these HCPs per study group. | NI | -Physician reminder: 1471 -Letter reminder: 1541 -Telephone reminder | -Nonrandomized control: 2619 -Randomized control: 1403 | Influenza: Older than 65 years Tetanus: Over 18 years of age | Comparison of: -Physician reminder (paper) -Letter reminder to patients -Telephone reminder to patients | Vaccination rates |
Rosser, Hutchison [35] | 4 teaching medical practices participated, but no information was provided on the distribution of these HCPs per study group. | NI | -Physician reminder: 1399 -Letter reminder: 1471 -Telephone reminder: 1390 | Control: 1329 | Patients 20 years of age or more | Comparison of: -Physician reminder (paper) -Letter reminder to patients -Telephone reminder to patients | Vaccination rates |
Schreiner, Petrusa [37] | 20 residents | 22 residents | 1260 | 504 | -65 years and older or when having a chronic disease | -Five months with reminders (paper) followed by six months follow-up without reminders | Proportion of vaccines offered |
Shevlin, Summers-Bean [53] | 2 floors | 2 floors | 296 | 238 | -65 years and older or when in risk group (diabetes, alcohol abuse, lung/heart disease, HIV, chronic renal failure) | -Reminders (paper) + in-service education + feedback | Vaccination rates |
Shultz, Malouin [68] | 5 family medicine clinics | 4 primary care clinics | 39,882 | 28,032 | 11- to 64-year-old patients | Intervention consisting of: -Reminder (digital) -Pay-for-performance -Monthly status reports | Vaccination rates |
Siriwardena [54] | 15 | 15 | Influenza vaccination 65+: 13,633 | Influenza vaccination 65+: 13,947 | -65 years and older or when in risk group (coronary heart disease, diabetes, or splenectomy) | Comparison of: -Educational outreach based on principles of academic detailing + audit feedback and written guidance -Audit feedback and written guidance | Vaccination rates |
Solberg, Kottke [55] | 22 clinics | 22 clinics | 3379 | 3451 | Older than 64 years | - Leadership involvement, training, network and consultation | Vaccination rates |
Stevenson, McMahon [56] | Alaska: 26 facilities Idaho: 23 facilities Montana: 78 facilities Wyoming: 6 facilities | n/a | Alaska: 1099 Idaho: 1274 Montana: 5671 Wyoming: 882 | n/a | All residents | Comparison of 4 slightly different multicomponent interventions | Vaccination rates |
Tang, LaRosa [38] | 13 | 10 | NI | NI | Patients 65 years of age and older | Reminder (digital) | Behaviour among HCWs |
Tape and Campbell [39] | 45 residents in total and 4 attending physicians. No information on the numbers assigned to the control/intervention arm | See under ‘Intervention’ | Tetanus: 937 Influenza: 212 Pneumococcal: 310 | Tetanus: 870 Influenza: 172 Pneumococcal: 274 | -Influenza: 65 years and older or when in risk group (diabetes, chronic respiratory or heart disease) -Pneumococcal: 65 years and older or when in risk group (immunocompromised, diabetes, chronic respiratory or heart disease) -Tetanus: all patients | Comparison of: -Education + flow sheet -Education + reminder (six months on paper, then six months displayed on terminals) | Behaviour among HCWs |
Tierney, Hui and McDonald [40] | -Group A feedback and A reminders: 33 - Group A feedback and B reminders: 31 -Group B feedback and A reminders: 36 | Group B feedback and B reminders: 35 | -Group A feedback and A reminders: 1487 - Group A feedback and B reminders: 1451 -Group B feedback and A reminders: 1606 | Group B feedback and B reminders: 1501 | Unclear | Various combinations feedback and reminders (paper) | Behaviour among HCWs |
Trick, Das [57] | NI | NI | -Nursing reminder: 69 -Opt-out: 66 | Control:69 | All patients (median age: 52 years) | Comparison of: -Standing-orders policy -Augmentation of the standing-orders policy with electronic opt-out orders for physicians -Augmentation of the standing-orders policy with electronic reminders to nurses | Vaccination rates |
Turner, Waivers and O’Brien [42] | 12 residents | 12 residents | 117 | 246 | Both vaccines: older than 65 or in risk group | Comparison of: -Physician reminder (paper) -Physician reminder (paper) + reminder card carried by patients | Vaccination coverage |
Turner, Peden and O’Brien [41] | -Computer-generated reminder: 15 physicians -Patient-carried reminder: 22 physicians | n/a | -Computer-generated reminder: 300 -Patient-carried reminder: 440 | n/a | 65 years or older or suffering from a chronic disease | Comparison of: -Physician reminder (paper) -Reminder card carried by patients | Vaccination coverage |
van Essen, Kuyvenhoven and de Melker [43] | 64 practices (84 GPs) | 74 practices (88 GPs) | about 250,000 | about 300,000 | All patients | Guideline for influenza vaccination | -Vaccination coverage -Organization level |
Warner and Seleznick [58] | 1 clinic | 1 clinic | NI | NI | Patients 65 years of age or older | Comparison of: -Education + reminder (paper) -Education only | -Vaccination rates -Organization level |
Winston, Lindley and Wortley [59] | -A: 93 (50-64y, 2002) 90 (50-64y, 2003) 93 (65 + y, 2002) 87 (65 + y, 2003) -B: 39 (50-64y, 2002) 49 (50-64y, 2003), 98 (65 + y, 2002) 114 (65 + y, 2003) -C: 109 (50-64y, 2002), 95 (50-64y, 2003), 110 (65 + y, 2002), 96 (65 + y, 2003) -D 112 (50-64y, 2002) 91 (50-64y, 2003) 102 (65 + y, 2002) 98 (65 + y, 2003) | n/a | 4 Hospitals (A-D) | n/a | Patients aged 50 years and older | Comparison of: -A. Nurse-administered standing orders protocol + Training and information: Small group meetings on individual units -B. Physician reminder program + Training and information: E-mail, newsletters, and division meetings -C + D Nurse-administered standing orders protocol + Training and information: Nurse managers trained during regular staff meetings | Vaccination rates |
Yi, Zhou [69] | NI | NI | 7013 | 5500 | 60 years and older + chronic disease | Education | Vaccination coverage |