Randomised controlled trials (RCTs) and cluster-RCTs of interventions to increase influenza vaccination in people aged 60 years or

Cochrane Database of Systematic Reviews

Interventions to increase influenza vaccination rates of those

60 years and older in the community (Review)

Thomas RE, Lorenzetti DL

Thomas RE, Lorenzetti DL.

Interventions to increase influenza vaccination rates of those 60 years and older in the community.

Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188.

DOI: 10.1002/14651858.CD005188.pub4.

www.cochranelibrary.com

Interventions to increase influenza vaccination rates of those 60 years and older in the community (Review)

Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.http://www.cochranelibrary.com

T A B L E O F C O N T E N T S

1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . .

8BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Figure 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

27ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . .

32DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

34AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

58CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

162DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analysis 1.1. Comparison 1 Increasing community demand, Outcome 1 Client reminder and recall (postcard) compared to

no intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

Analysis 1.2. Comparison 1 Increasing community demand, Outcome 2 Client reminder and recall (tailored letter or

postcard or phone call) compared to no intervention. . . . . . . . . . . . . . . . . . . . . 166

Analysis 1.3. Comparison 1 Increasing community demand, Outcome 3 Client reminder and recall (letter + leaflet or

postcard) compared to letter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Analysis 1.4. Comparison 1 Increasing community demand, Outcome 4 Client reminder and recall (customised letter or

phone call) compared to form letter. . . . . . . . . . . . . . . . . . . . . . . . . . . 168

Analysis 1.5. Comparison 1 Increasing community demand, Outcome 5 Client reminder and recall (telephone call from

retired teacher plus educational brochure) compared to usual publicity. . . . . . . . . . . . . . . 168

Analysis 1.6. Comparison 1 Increasing community demand, Outcome 6 Client reminder and recall (telephone invitation)

compared to invitation to patient when “dropped in” to clinic. . . . . . . . . . . . . . . . . . 169

Analysis 1.7. Comparison 1 Increasing community demand, Outcome 7 Brochure + lottery for free groceries compared to

no intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Analysis 1.8. Comparison 1 Increasing community demand, Outcome 8 Questionnaires to clients about attitudes. . 170

Analysis 1.9. Comparison 1 Increasing community demand, Outcome 9 Client-based education (health risk appraisal)

compared to no intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

Analysis 1.10. Comparison 1 Increasing community demand, Outcome 10 Client-based education (nurses or pharmacists

educated and nurses vaccinated patients) compared to no intervention. . . . . . . . . . . . . . . 172

Analysis 1.11. Comparison 1 Increasing community demand, Outcome 11 Client-based education (nurses educated and

vaccinated patients) compared to nurses educated patients. . . . . . . . . . . . . . . . . . . 172

Analysis 1.12. Comparison 1 Increasing community demand, Outcome 12 Face-to-face 3-minute conversation compared

to no intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Analysis 2.1. Comparison 2 Enhancing vaccination access, Outcome 1 Group visits of patients to physician and nurse

compared to usual care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

Analysis 2.2. Comparison 2 Enhancing vaccination access, Outcome 2 Home visit compared to invitation to attend

influenza vaccination clinic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

Analysis 2.3. Comparison 2 Enhancing vaccination access, Outcome 3 Home visit with encouragement to receive influenza

vaccination, compared to home visit with safety intervention. . . . . . . . . . . . . . . . . . 175

iInterventions to increase influenza vaccination rates of those 60 years and older in the community (Review)

Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Analysis 2.4. Comparison 2 Enhancing vaccination access, Outcome 4 Home visit by nurse or group sessions with

encouragement to receive influenza vaccination, plus care plan developed with physician, compared to no

intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Analysis 2.5. Comparison 2 Enhancing vaccination access, Outcome 5 Free influenza vaccine compared to invitation to be

vaccinated but patient pays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Analysis 2.6. Comparison 2 Enhancing vaccination access, Outcome 6 Free influenza vaccine compared to no

intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Analysis 3.1. Comparison 3 Provider- or system-based intervention, Outcome 1 Reminder (to physician) compared to no

reminder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Analysis 3.2. Comparison 3 Provider- or system-based intervention, Outcome 2 Reminder to physician about all patients

compared to reminder about half patients. . . . . . . . . . . . . . . . . . . . . . . . . 178

Analysis 3.3. Comparison 3 Provider- or system-based intervention, Outcome 3 Reminder (to hospital staff to vaccinate

patient) compared to letter to GP on day of discharge. . . . . . . . . . . . . . . . . . . . . 179

Analysis 3.4. Comparison 3 Provider- or system-based intervention, Outcome 4 Posters in clinic displaying influenza

vaccination rates to encourage doctors to compete, plus postcards to patients, compared to no intervention. . 180

Analysis 3.5. Comparison 3 Provider- or system-based intervention, Outcome 5 Posters in clinic displaying influenza

vaccination rates to encourage doctors to compete, plus postcards to patients, compared to posters displaying

vaccination rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Analysis 3.6. Comparison 3 Provider- or system-based intervention, Outcome 6 Facilitator encouragement of prevention

manoeuvres including influenza vaccination compared to no intervention. . . . . . . . . . . . . . 181

Analysis 3.7. Comparison 3 Provider- or system-based intervention, Outcome 7 Educational reminders, academic detailing,

and peer comparisons to physicians compared to mailed educational materials. . . . . . . . . . . . 182

Analysis 3.8. Comparison 3 Provider- or system-based intervention, Outcome 8 Chart review and feedback to physician

plus benchmarking to vaccination rates achieved by top 10% of physicians, compared to chart review and feedback. 182

Analysis 3.9. Comparison 3 Provider- or system-based intervention, Outcome 9 Educational outreach + feedback to

practice teams versus written feedback to practice teams. . . . . . . . . . . . . . . . . . . . 183

Analysis 3.10. Comparison 3 Provider- or system-based intervention, Outcome 10 Payment to physicians versus no

payment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Analysis 3.11. Comparison 3 Provider- or system-based intervention, Outcome 11 Intervention to increase staff influenza

vaccination rate versus no intervention. . . . . . . . . . . . . . . . . . . . . . . . . . 184

185ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

189APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

195FEEDBACK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

197WHAT’S NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

197HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

198CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

198DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

198SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

199DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . .

199INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

iiInterventions to increase influenza vaccination rates of those 60 years and older in the community (Review)

Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

[Intervention Review]

Interventions to increase influenza vaccination rates of those 60 years and older in the community

Roger E Thomas1 , Diane L Lorenzetti2

1Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada. 2Department of Community Health

Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada

Contact address: Roger E Thomas, Department of Family Medicine, Faculty of Medicine, University of Calgary, Health Sciences

Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. rthomas@ucalgary.ca.

Editorial group: Cochrane Acute Respiratory Infections Group.

Publication status and date: Edited (no change to conclusions), published in Issue 7, 2018.

Citation: Thomas RE, Lorenzetti DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community.

Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4.

Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

A B S T R A C T

Background

The effectiveness of interventions to increase influenza vaccination uptake in people aged 60 years and older varies by country and

participant characteristics. This review updates versions published in 2010 and 2014.

Objectives

To assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and

older in the community.

Search methods

We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group’s Specialised Register, MEDLINE, Embase,

CINAHL, and ERIC for this update, as well as WHO ICTRP and ClinicalTrials.gov for ongoing studies to 7 December 2017. We

also searched reference lists of included studies.

Selection criteria

Randomised controlled trials (RCTs) and cluster-RCTs of interventions to increase influenza vaccination in people aged 60 years or

older in the community.

Data collection and analysis

We used standard methodological procedures as specified by Cochrane.

Main results

We included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older

living in the community in high-income countries. Heterogeneity limited some meta-analyses. We assessed studies as at low risk of bias

for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing

data. We assessed the evidence as low-quality. We identified three levels of intervention intensity: low (e.g. postcards), m