Targeted Vaccinations: Multiple Interventions Implemented in Combination

Most of the available evidence on effectiveness identified in our reviews of interventions to increase targeted vaccine coverage came from studies that evaluated multiple interventions in combination. These studies evaluated a wide variety of intervention combinations.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force recommends interventions that include the combination of interventions as indicated below, based on strong evidence of their effectiveness in increasing targeted vaccination coverage.

• An intervention to enhance access to vaccination services (expanded access in healthcare settings, reduced client out-of-pocket costs), and
• At least one provider- or system-based intervention (standing orders, provider reminder systems, provider assessment and feedback), and/or
• At least one intervention to increase client demand for vaccination (client reminders, client education).

Task Force Finding

Results from the Systematic Reviews

Combinations of specific interventions have proven effectiveness for increasing targeted vaccine coverage. These combinations, and descriptions of the component interventions, are shown below.

Recommended intervention combinations to increase targeted vaccination coverage	Examples or descriptions of interventions
ONE OR BOTH of these interventions to enhance access to vaccination services:
Expanded access in healthcare settings	Increase availability of vaccinations by adding locations or increasing hours, or by removing administrative barriers
Reducing client out-of-pocket costs	Pay for vaccinations or administration, provide insurance coverage or reduce co-payments for vaccinations
PLUS: ONE OR MORE of these interventions that are provider-oriented:
Standing orders	Authorize nurses, pharmacists and other licensed healthcare personnel, where allowed by state law, to assess a client's immunization status and give vaccinations without direct involvement of the attending clinician at the time ofthe interaction
Provider reminder systems	Let clinicians or other appropriate staff know when individual clients are due for vaccinations, through notations, stickers, or other prompts in clients’ charts, computer databases, or registries
Provider assessment & feedback	Assess the clinician’s performance in delivering one or more vaccinations to clients and provide assessment results to the provider
AND/OR: ONE OR BOTH of these interventions to increase client demand for vaccination services:
Client reminder systems	Provide information or advice directly to individual clients who are at increased risk to encourage them to obtain appropriate vaccinations
Client education	Provide information on vaccinations to clients while they are being served in a medical or public health clinic setting

Twenty-three qualifying studies provided 26 study arms evaluating 22 different combinations of interventions for the systematic review.

• Vaccination coverage: median increase of 16.5 percentage points (range: -5.9 to 67.0 percentage points; 16 studies, 19 study arms)
• These results should be applicable in most client and provider populations and most settings where improvements in coverage are needed.
• Evidence was insufficient to determine the effectiveness of other combinations of interventions in increasing coverage.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to vaccinations to prevent diseases.

Economic Review

No economic evaluations were found for this intervention.

Supporting Materials

• Analytic framework [PDF - 728KB] - see Figure 1 on page 251

Publications

CDC. Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2005;54(No. RR-5):1-12.

Task Force for Community Preventive Services. Recommendations to improve targeted vaccination coverage among high-risk adults. [PDF - 97KB] Am J Prev Med 2005:28(5S);231-7.

Ndiaye SM, Hopkins DP, Smith SJ, et al. Methods for conducting systematic reviews of targeted vaccination strategies for The Guide to Community Preventive Services. [PDF - 132KB] Am J Prev Med 2005:28(5S);238-47. 

Ndiaye SM, Hopkins DP, Shefer AM, et al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. [PDF - 728KB] Am J Prev Med 2005:28(5S);248-79.

Task Force on Community Preventive Services. Vaccine preventable diseases. [PDF - 97KB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:223-303.

More Community Guide publications about Vaccinations to Prevent Diseases

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Targeted vaccinations: multiple interventions implemented in combination. www.thecommunityguide.org/vaccines/targeted/multi-combination.html. Last updated: MM/DD/YYYY.

Review completed: October 2002