Vaccination Programs: Client-Held Paper Immunization Records

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Snapshot

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether client-held paper immunization records increase vaccination rates. Studies reported inconsistent findings on a variety of programs.

Intervention

Client-held paper immunization records document an individual’s vaccination status. Clients or their families can use them to track their status and see which vaccinations are recommended at which times. Healthcare providers can use them to determine when and where clients received vaccinations. Client-held paper immunization records may be used alone or with more comprehensive health records.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement pdf icon [PDF - 495 KB] for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2010 (7 studies, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-February 2012). This updates and replaces the 2010 finding for Client-Held Paper Immunization Records pdf icon [PDF - 516 KB].

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.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement [PDF - 495 KB].

The systematic review included 8 studies with 11 study arms.

Overall vaccination rates increased by a median of 5.3 percentage points (6 studies with 9 study arms).

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

How effective are activities aimed at increasing the retention and use of client-held paper immunization records for children by their parents or other caregivers?
What is the impact of electronic health records or immunization information systems on intervention effectiveness?

Study Characteristics

Included studies used client-held paper immunization records as part of multicomponent efforts. Comparison groups received one or more interventions.

Supporting Materials

Analytic Framework

Effectiveness Review

Analytic Framework pdf icon [PDF - 106 KB]

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

Effectiveness Review

Summary Evidence Table - Effectiveness Review pdf icon [PDF - 155 KB]

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Dickey LL, Petitti D. Patient-held minirecord to promote adult preventive care. J Fam Pract 1992;34:457– 63.

Dietrich AJ, Duhamel M. Improving geriatric preventive care through a patient-held checklist. Fam Med 1989;21:195–8.

McElligot JT, Darden PM. Are patient-held vaccination records associated with improved vaccination coverage rates? Pediatrics 2010; 125 (3): e467–72.

O’Sullivan AL, Jacobsen BS. Randomized trial of a health care program for first-time adolescent mothers and their infants. Nurs Res 1992;41: 210–5.

Stevens-Simon C, Kelly L, Brayden RM. A health passport for adolescent parents and their children. Clin Pediatr 2001;40(3):169–72.

Thomas P, Joseph TL, Menzies RI. Evaluation of a targeted immunisation program for Aboriginal and Torres Strait Islander infants in an urban setting. NSW Public Health Bull 2008;19(5-6):96–9.

Turner RC, Waivers LE, O’Brien K. Effect of patient-carried reminder cards on the performance of health maintenance measures. Arch Intern Med 1990;150:645–7.

Turner RC, Peden JG Jr, O’Brien K. Patient-carried card prompts vs computer-generated prompts to remind private practice physicians to perform health maintenance measures. Arch Intern Med 1994;154(17);1957–60.

Search Strategies

Effectiveness Review

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

Search Terms

Immunization
Vaccination
Immunization Programs

Considerations for Implementation

Despite the finding of insufficient evidence, the following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

Paper immunization records may be useful when they are used consistently—when providers update them and parents keep track of them.
Children are more likely to receive recommended vaccinations and avoid being over-vaccinated. This is especially true when children are seen in nontraditional immunization settings, such as emergency departments.
Barriers to use identified in the included studies and broader literature include the following:
- Clients’ declining interest over time and low card retention.
- Healthcare providers’ concerns about time management when using a preventive services checklist.
Client-held paper immunization records will continue to be useful until issues of privacy, security, and quality of electronic records have been resolved.
Paper records will continue to be useful for clients on the other side of the "digital divide." This may be particularly true for some populations, such as clients with limited computer access and adults whose change in employment status is accompanied by a change in providers.
Included studies reported that client-held records used for vaccination and other health purposes increased clients' receipt of some preventative services.
In settings where other records of immunization history are not readily available, such as emergency rooms, client-held paper immunization records may reduce administration of unnecessary vaccinations, associated costs, and clients' discomfort.
No harms of client-held paper immunization records were identified.

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Vaccination Programs: Client-Held Paper Immunization Records

Tabs

Summary of CPSTF Finding

Intervention

CPSTF Finding and Rationale Statement

Users who viewed this also viewed

About The Systematic Review

Summary of Results

Summary of Economic Evidence

Applicability

Evidence Gaps

Study Characteristics

Analytic Framework

Effectiveness Review

Summary Evidence Table

Effectiveness Review

Included Studies

Effectiveness Review

Search Strategies

Effectiveness Review

Details of the original search (1980-1997)

Details of the update search (1997- February 2012)

Search Terms

Considerations for Implementation

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