Table 4.
Study characteristics of provider-based interventions
| Paper | Study period | Setting and population | Design | Quality | Intervention | Outcome |
|---|---|---|---|---|---|---|
| Burns et al.38 | 1995–1996 | Two family health centres, Pittsburgh, Pennsylvania, USA; children aged up to 6 years; 448 intervention group, 529 control group | Randomized controlled trial | 25 | 1. Usual care (control group) vs. 2. Chart prompt |
1 vs. 2: Immunisation with DTP4 net change 15% (P = 0.03); Immunisation with MMR 1 net change 16% (P = 0.01); Immunisation with OPV3 net change 14% (P = 0.04); Immunisation with DTP3, DTP5, HepB3 and OPV4, no statistically significant difference 1 vs. 2 |
| Christy et al.39 | 1990–1991 | Two hospital-based primary care centres, Rochester, New York, USA; Children aged 2 to 60 months old; Urban | Controlled intervention trial | 21 | 1. Usual care at site 2, 1 July 1991–6 December 1991 (concurrent control group) vs. 2. Nursing intervention guided by an algorithm form at site 1 during same period vs. 3. Usual care at site 1, 1 July 1990 and 30 November 1990 (retrospective control group) |
Up to date with DTP/OPV/MMR/Hib aged 24–36 months net change 1 vs. 2 = 0.4%, 2 vs. 3 = 10% (significance not tested) |
| Fairbrother et al.47 | 1995–1996 | Family and paediatric practices in nine neighbourhoods, New York City, USA; low socioeconomic status | Randomized controlled trial | 24.5 | 1. Usual care (control group) vs. 2. Physician bonus and feedback vs. 3. Enhanced fee for service and feedback 4. Feedback only |
UTD with DTP/Hib/OPV/MMR 8 months after baseline, 1 vs. 2 net change = 19.2% (P < 0.01), no significant difference between group 3 or 4 and control group |
| Fiks et al.40 | 2004– 2005 | Four urban primary care centres, Philadelphia, Pennsylvania, USA; children under 24 months old; >80% ethnic minorities | Before and after study | 27 | 1. Usual care (control group) vs. 2. Electronic Health Record-based clinical reminders |
1 vs. 2: Up to date for 4DTP/3IPV/1MMR/3Hib/3HepB/1varicella In well child net change 33% (95% CI 32.2–34.6), in sick child 22% (95% CI 20.6–23.1) |
| Franzini et al.43 | 2003–2005 | Paediatric and family health practices, Greater Houston, Texas, USA; children aged 12–23 months of age | Before and after study | 20.5 | 1. Usual care vs. 2. 1-hour peer-based educational lunch presentation |
Immunisation rates 1 vs. 2 net change = 4% (not significant) |
| Harper et al.48 | October 1993–October 1994 | Family practice clinic (intervention), community health centre (control), St Paul, Minnesota, USA; children aged 24–35 months old; predominantly white, low socioeconomic group | Controlled intervention trial | 23 | 1. Usual care (non-equivalent control group) vs. 2. Physician chart reminder plus feedback on performance plus patient education |
4:3:1 DTP/OPV/MMR respectively, 1 vs. 2= 12% net change (P <0.02) |
| Margolis et al.44 | Not reported | 44 primary care practices, North Carolina, USA; children aged 24–30 months | Randomized controlled trial | 28 | 1. Usual care (control group) vs. 2. Practice-based continuing medical education |
Immunisation rates at 30 months post randomization 1 vs. 2 net change 0.6% (significance not reported) |
| Sinn et al.49 | Not reported | Ten paediatric group practices, Virginia Beach, Virginia, USA; children aged 9–30 months | Before and after trial | 21 | 1. Usual care (control group) vs. 2. ‘The physician leadership model’ including peer influence and review and goal setting with feedback |
Up to date with immunisations at 24 months 1 vs. 2 net change 18.8% (P < 0.001) |
| Smith et al.45 | 1994 | Children under 2 years of age; low income families | Before and after study | 21 | 1. Usual care vs. 2. Physician education plus free vaccines and assistance with billing disputes |
UTD for age, 1 vs. 2, net change = 25% (P < 0.00001) |
| Soljak and Handford41 | 1985 | Clinics and offices, Northland, New Zealand; all children born during study periods | Controlled intervention trial for patient reminders; before and after study for provider reminders | 21 | 1. Retrospective control group vs. 2. GP reminder vs. 3. GP reminder plus postal reminder cards |
Up to date ‘with all appropriate antigens’ at 5 months 2 vs. 3 net change 0.4% (p = 0.86); 1 vs. 2 and 3 net change 4% (P = 0.034) |
| Szilagyi et al.42 | 1991–1993 | Teaching hospital paediatric clinic and neighbourhood health centre, Rochester, New York, USA; children aged up to 2 years (mean ages 7–13 months); 1988 participants before randomization; urban; low socioeconomic status | Randomized controlled trial | 24.5 | 1. Usual care (control group) 2. Provider chart reminders |
UTD with DTP/OPV/MMR/Hib, 1 vs. 2 net change = 3% at clinic (P = 0.3) and −2% at health centre (P = 0.5) |
| Taylor et al.50 | Not reported | Private paediatric and family clinics, King County, Washington, USA; children aged 3–19 months | Randomized controlled trial | 28 | 1. Immunisation rate feedback and assessment of current immunisation procedures 2. As above plus peer educational programme |
Immunisation rate 1 vs. 2 net change = 2.2% (P = 0.24) |
| Waterman46 | 1992–1994 | San Diego, California, USA; children aged 2–4 years; low socioeconomic status | Controlled intervention trial | 20 | 1. Usual care (control group) 2. Walk-in clinics plus provider education plus patient reminders plus education and health promotion |
DTP/OPV/MMR (4:3:1) 1 vs. 2 net change = 12% (not significant) |