Summary of findings for the main comparison.
Summary of effects of interventions to increase influenza vaccination uptake
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Population: all ≥ 60, any country Settings: living in the community (no RCTs were found for seniors living in institutions) Intervention: any intervention to increase influenza vaccinations | |||||
| Interventions | Number of participants in control (C) and intervention (I) Number of (RCTs) | Comparison | Outcomes: vaccination rates |
Quality of evidence (GRADE) |
Comments |
| I. Increasing community demand: reminders to participants | I = 30,377; C = 162,609 (10) | No intervention | 3 of 10 RCTs (and 3 of 4 largest) showed positive effect with entire 95% CI > 1 | ⊕⊕ 1 Low |
Data could not be pooled |
| I. Increasing community demand: tailored reminders to participants | I = 40,301; C = 166,927 (11) | No intervention | 6 of 11 RCTs (and all 5 of largest) showed positive effect with entire 95% CI > 1 | ⊕⊕ 2 Low |
Data could not be pooled due to heterogeneity |
| I. Increasing community demand: educating and vaccinating participants plus offer of vaccination | I = 293; C = 321 (2) | No intervention | Pooled OR 3.29 (95% CI 1.91 to 5.66); P value < 0.0001 | ⊕ 3 Very low |
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| I. Increasing community demand: health risk appraisal plus offer of vaccination | I = 1228; C = 781 (1) | No intervention | OR 2.17 (95% CI 1.70 to 2.77); P value < 0.00001 | ⊕⊕4 Low |
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| II. Increasing access: home visits | I = 710; C 1402 (2) ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ I = 73; C = 69 (1) vaccination plus care plan developed with physician ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ I = 198; C = 152 (1) |
"usual care" ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ No intervention ‐‐‐‐‐‐‐‐‐‐‐‐‐ Safety intervention |
For 2 studies which could be pooled OR 1.30 (95% CI 1.05 to 1.61); P value = 0.01 ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ OR 8.15 (95% CI 3.28 to 20.29); P value < 0.00001 ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ OR 0.98 (95% CI 0.64 to 1.50); P value = 0.92 |
⊕⊕⊕ 5 Moderate |
2 studies were not pooled due to heterogeneity of the interventions |
| II. Increasing access: free vaccine | I = 1125; C = 1126 (2) | Patient paid | Pooled OR = 2.36 (95% CI = 1.98 to 2.82); P value < 0.0001 | ⊕ 6 Very low |
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| III. Provider‐ or system‐based interventions: reminders to physicians | I = 979; C = 2437 (4) | No intervention | 1 of 4 RCTs showed positive effect with entire 95% CI > 1 | ⊕⊕⊕ 7 Moderate | Data could not be pooled due to heterogeneity |
| III. Provider‐ or system‐based interventions: Facilitators working with practices |
I = 95,987; C = 90.272 (4) | No intervention | 3 of 4 RCTs showed positive effect with entire 95% CI > 1 | ⊕⊕⊕ 8 Moderate |
Data could not be pooled due to heterogeneity |
| III. Provider‐ or system‐based interventions: education and feedback to physicians | I = 15,017; C = 15,323 (3) | Chart review and feedback | 1 RCT which compared chart review and feedback plus benchmarking to the vaccination rates achieved by the top 10% of physicians found OR 3.43 (95% CI 2.37 to 4.97); P value < 0.0001 1 RCT found no effect and 1 found educational outreach and feedback less effective than written feedback (OR 0.77, 95% CI 0.72 to 0.81); P value < 0.00001 |
⊕ 9 Very low |
Data could not be pooled due to heterogeneity |
| III. Provider‐ or system‐based interventions: financial incentives to physicians | I = 1559; C = 1256 (2) | Payment per vaccination | Pooled OR 2.22 (95% CI 1.77 to 2.77); P value < 0.0001 | ⊕⊕ 10 Low |
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C: control CI: confidence interval I: intervention OR: odds ratio
GRADE quality of evidence (based on risk of bias, heterogeneity, indirectness, imprecision and reporting bias) ⊕⊕⊕⊕: High quality. Further research is very unlikely to change our confidence in the estimate of effect. ⊕⊕⊕ Moderate quality. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. ⊕⊕ Low quality. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. ⊕ Very low quality. We are very uncertain about the estimate.
1Only two RCTs reported adequate sequence generation, one concealment, two blinding, five addressed incomplete data and eight were free of selective reporting. 2Only two RCTs reported adequate sequence generation, none concealment, one blinding, seven addressed incomplete data and 10 were free of selective reporting.
3Neither RCT reported adequate sequence generation or concealment or blinding, one addressed incomplete data and both were free of selective reporting.
4This RCT did not report adequate sequence generation, concealment or blinding, but addressed incomplete data and was free of selective reporting.
5Two RCTs reported adequate sequence generation, one concealment, one blinding and all four addressed incomplete data and were free of selective reporting.
6Neither RCT reported adequate sequence generation, concealment, blinding or addressed incomplete data, but both were free of selective reporting.
7Two RCTs reported adequate sequence generation, one concealment, one blinding and all four addressed incomplete data and were free of selective reporting.
8Two RCTs reported adequate sequence generation, concealment and blinding, three addressed incomplete data and all four were free of selective reporting.
9None of the RCTs reported adequate sequence generation, concealment, blinding or addressed incomplete data, and two of the three were free of selective reporting.
10Neither RCT reported adequate sequence generation, concealment or blinding, but both addressed incomplete data and were free of selective reporting.