Recommendations of the Task Force on Community Preventive Services to Improve Vaccination Coverage in Children
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1 Recommendations of the Task Force on Community Preventive Services to Improve Vaccination Coverage in Children Topeka, Kansas March 13, 2006 Gianfranco Pezzino, M.D., M.P.H. Director of Public Health Studies Kansas Health Institute
2 U.S. Preventive Services Task Force About 12 members appointed by CDC Director Independent decision-making body Produces evidence-based guidelines for community interventions Over 100 findings across nine topic areas
3 Vaccine-Preventable Diseases Review Methods Over 250 research papers reviewed and evaluated 19 interventions grouped in 3 strategies: 1) Increasing community demand for vaccinations 2) Enhancing access to vaccination services 3) Provider-based interventions Evidence-based recommendation for each intervention Recommended (strong Recommended (sufficient Insufficient evidence to determine effectiveness Discouraged (evidence of ineffectiveness or harm) Review released in 2000, updated in 2005
4 1. Interventions for Increasing Community Demand for Vaccinations Client reminder/ recall systems Recommended (strong Multicomponent interventions + education Requirements for child care or school attendance Community-wide education only Clinic-based education only Client or family incentives Client-held medical records Recommended (strong Recommended (sufficient Insufficient evidence to determine effectiveness Insufficient evidence Insufficient evidence Insufficient evidence
5 2. Interventions for Enhancing Access to Vaccination Services Reducing out-of-pocket costs Expanding access + multicomponent intervention Expanding access only Programs in women, infants, & children (WIC) settings Home visits Programs in child care centers Recommended (strong Recommended (strong Insufficient evidence to determine effectiveness Recommended (sufficient Recommended (sufficient Insufficient evidence to determine effectiveness
6 3. Provider-Based Interventions Provider reminder/recall systems Assessment & feedback for providers Standing orders adults Standing orders children Provider education only Recommended (strong Recommended (strong Recommended (strong Insufficient evidence to determine effectiveness Insufficient evidence to determine effectiveness
7 Summary of Recommended Interventions 1) Increasing community demand for vaccinations Client reminder/recall systems to increase vaccination coverage Multicomponent interventions that include education Requiring vaccinations for child care, school, and college attendance
8 Summary of Recommended Interventions 2) Enhancing access to vaccination services Reducing out-of-pocket costs Multicomponent programs to expand access Vaccination programs in WIC (Women, Infants, and Children) settings Home visits
9 Summary of Recommended Interventions 3) Provider-based interventions Provider reminder/recall systems Assessment and feedback for vaccination providers Standing orders in adults Insufficient evidence on standing orders for children: Greater complexity of protocols Only 1 study, limited in design, methods and results
10 Conclusions Insufficient evidence to recommend some traditional interventions, e.g.: Education only activities for providers, communities or clients Client or family incentives Many interventions recommended as multicomponent strategies Need for local assessment, local strategies Even generally effective strategies are unlikely to achieve objectives if they are poorly matched to local needs. 1 1 Task force on community preventive services
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