Strategies to improve vaccination uptake in Australia

Transcription

1 Strategies to improve vaccination uptake in Summary of included studies by intervention category Increase community demand (n=20) Primary Sample size Intervention(s) Outcomes onclusion Limitations Ballestas (2009) Fremantle, Western Health care workers (HWs) Over 11,000 staff in 5 hospitals Social marketing campaign + education Vaccination n vaccinated = 6,387 overage = 55% Variation in data collection methods overage could be overestimated Respondent bias Banks n apital Territory ( hildren 877 parents of children aged <5 years overdue for immunisation Recall letters + updating records 78% of initially overdue children were up to date Bartu (2006) Perth, Western (RT e ) hildren 150 children Intervention = 75 ontrol = 75 Home visits + education for women post-partum No significant differences were detected in immunisations at 2 months (p=0.757), 4 months (p=0.477) or 6 months (p=0.283) post-partum between intervention group and No significant differences in between intervention group and Self-report bias Insufficient power to detect clinically significant differences Selection bias Byrnes (2006) Bundaberg, Queensland Older people 580 patients Reminder letters + free appointments + nurse-led immunisation Vaccination 2004 = 77% 2005 = 83% Potential temporal confounders De Alwis post HWs 17 hospitals Multi-component interventions: education programs; mobile vaccination cart; declination forms; incentives; promotions; communication Average n public hospitals = 48.3% Study hospitals = 54.3% Less than half (5/17) the study hospitals achieved state target of 60% Inverse relationship between vaccination and number of acute beds smaller hospitals achieved higher Support and resources are a more important barrier to achieving high rates than the failure to use evidencebased strategies Subjective assessments Measurement tools not validated Difficulty in obtaining accurate estimates Highly correlated nature of the variables limited statistical analysis Summary of strategies to increase vaccination uptake in Page 1 of 13

2 Sample size Intervention(s) Outcomes onclusion Limitations Devine (2007) St Albans and Maldon, Behaviourally at risk (prisoners) 204 prisoners Integrate vaccination with health assessments Vaccination dose 1 = 83% dose 2 = 93% dose 3 = 84% Achieved high Activities limited due to challenging population Ferguson (retrospective cohort) Medically at risk (haematopoietic stem cell transplant [HST] patients and their families) 205 children Patient education + reminder letter to general practitioner (GP) Vaccination Participants = 71% Non-participants = 30% Higher in intervention group than Selection bias Social desirability bias Self-report bias Not all interventions evaluated Fullerton Across Queensland HWs Around 7,400 employees State-wide coordination of influenza vaccine for HWs incl. staff education and promotional material Vaccination 2006 = 26% 2009 = 58% Hawe (1998) Ballarat, (RT e ) Measles-mumps hildren 259 parents Intervention = 124 ontrol = 135 Reminder postcard based on Health Belief Model Vaccination Intervention = 79% ontrol = 67% Higher in intervention group than onfounding Selection bias uraskova (2011) (RT e ) Human papillomavirus (HPV) First year university students, female, aged under students ervical cancer leaflet = 81 ervical cancer + genital warts leaflet = 78 Two different information leaflets with information about the HPV vaccine framed as protecting against (1) cervical cancer (2) cervical cancer + genital warts Vaccination 37% of total participants received vaccine 2 months after intervention Low HPV knowledge (22%) and high vaccination intention (79%) which was not influenced by information framing Vaccine intention does not equate to behaviour Participants may be interested in the vaccine High attrition Kirby hildren Not stated Recall letters Percentage up to date uly 2009 = 55% December 2009 = 70% Summary of strategies to increase vaccination uptake in Page 2 of 13

3 Sample size Intervention(s) Outcomes onclusion Limitations Lennox (2007) Queensland (RT e ) Tetanusdiphtheria + hepatitis B + influenza Medically at risk (adults with intellectual disability) 459 adults Intervention = 234 ontrol = 219 Integrate vaccination with health assessments Vaccination Tetanus-diphtheria Intervention = 25% ontrol = 3% Intervention = 16% ontrol = 7% Higher in intervention group than Potential information bias High staff turnover Intervention = 60% ontrol = 56% Puech (1998) (RT e ) Older people 325 elderly Intervention = 154 ontrol = 171 Reminder postcard Vaccination Intervention = 64% ontrol = 46% (p=0.05) Higher in intervention group than ontamination of the sample underestimated effects Scott post HWs Not stated Staff education + promotional material + mass vaccination clinics Number of vaccines administered to staff Seasonal influenza: 2,268 (65% uptake); average n uptake = 53% overage higher than jurisdictional average No formal evaluation activities undertaken Pandemic 2009 (H1N1) influenza vaccine: 1,548 (48% uptake) Skinner (2000) (RT e ) Adolescents (11 13 years of age) 17,411 students Intervention = 7,588 ontrol = 9,823 Education + promotional materials for students Vaccination, knowledge and attitudes towards hepatitis B vaccination (1) 93% completed the 3-dose course (similar for intervention and control schools) (2) overage increased by 4 10% between low vs high implementation in intervention schools No significant differences in between intervention group and Measurement deficiencies Summary of strategies to increase vaccination uptake in Page 3 of 13

4 Sample size Intervention(s) Outcomes onclusion Limitations Thomas Pneumococcal Aboriginal and Torres Strait Islander children GPs = 23 Babies = 13 Staff education + reminder stickers + patient promotion materials + Aboriginal Liaison Officers Vaccination from 30% to 40% (average for Sydney babies = 50%) Activities limited by the available resources Tomney Perth, Western hildren 35 general practices Recall letters + promotional materials based on a mascot Vaccination, provider and consumer feedback Pilot program 54.2% participating practices recorded a rise in AIR First year post-pilot 46% participating practices recorded an increase in AIR Van Buynder Western post hildren aged 6 59 months 546 parents Free vaccine available from GPs and large public clinic in metropolitan area AND public marketing campaign targeting parents/guardians (2 waves) using mass media and targeted promotional letters The peak uptake of vaccine occurred in the week the program commenced though there was no evidence of a boost in uptake following the second phase of the campaign (6 weeks post launch) Vaccination differed slightly by measurement method: ATI recruited dose 1 = 52% dose 2 = 47% WAIVE and sentinel GP recruited dose 1 = 52% dose 2 = 36% A targeted media campaign can increase vaccine uptake if it reinforces the seriousness of influenza illness and addresses community myths about the disease and vaccine. The use of dedicated vaccination clinics can also increase uptake. Self-report bias Non-random sample Influence of the healthy participant effect Influence of parental memory of childhood death cluster on vaccine uptake (not measured) Assessing the attributable benefit of mass marketing campaigns against high background rates Waddington- Powell Across South (cohort HWs Not stated Staff education + policy + promotional material Vaccination 2006 = 51% 2007 = 57% No formal evaluation activities undertaken Summary of strategies to increase vaccination uptake in Page 4 of 13

5 Sample size Intervention(s) Outcomes onclusion Limitations Wallace North oast, New South Wales Pneumococcal Aboriginal and Torres Strait Islander people and older people Not stated Mass media (TV advertisements) Vaccine ordering patterns Significantly higher (p<0.001) proportion of vaccines ordered 33% increase compared to the same period in the previous year orders for this vaccine Differences in effect not measured by target group Proxy measure used to estimate No assessment of participant awareness or factors impacting program implementation Summary of strategies to increase vaccination uptake in Page 5 of 13

6 Enhance access (n=15) Primary Sample size Intervention(s) Outcomes onclusion Limitations Bond (1998) (RT e ) dtpa g and MMR h hildren 169 children Intervention = 81 ontrol = 88 Home visits Vaccination and number of newborns up to date dtpa Intervention = 56% ontrol = 33% MMR Intervention = 57% ontrol = 23% Higher in intervention group than Randomisation strategy may have led to respondent bias Brown Logan ity, Queensland ( DTPa-IPV g MMR h hildren = 9 schools = 13 schools atch-up vaccines provided in primary schools Number of students vaccinated onsented = 490 (33%) Vaccinated previously = 350 (71%) Targeted for vaccination = 140 N targeted vaccinated = 97 (69%) Moderate increases in No formal evaluation activities undertaken Elia post All age groups Not stated Mass vaccination clinic (hospital) + promotional materials Number of vaccines administered 2005 = < = 2,338 No formal evaluation activities undertaken Types of target groups vaccinated: patients (71%), siblings (12%), parents (12%), staff (5%) Summary of strategies to increase vaccination uptake in Page 6 of 13

7 Sample size Intervention(s) Outcomes onclusion Limitations Fredericks Western (cohort) Hepatitis A and B (combined or monovalent, 3 doses, varying schedules) Medically at risk (adults newly diagnosed with hepatitis ) 1,209 notified hepatitis cases Government funded vaccine could be ordered by GPs upon notification of newly diagnosed hepatitis cases Notified cases ordering first dose of vaccine during study period = 37% Of those who ordered an initial dose, 30% placed final dose orders Older patients, those with unknown Indigenous status and non-indigenous patients were more likely to order at least one vaccine Higher uptake of these vaccines compared to previous studies Low course completion Administration of ordered vaccine Unlikely to have ordered vaccine(s) or completed course if patient was known to be immune to hepatitis A or B virus or had been partially vaccinated Vaccine uptake in this study higher than the 8 9% reported in previous studies Gill Hobart, Tasmania post Pandemic influenza All age groups All Tasmanians in Launceston and those attending the Taste of Tasmania in Hobart in 2009 Mass vaccination clinics (public gatherings) data about likelihood of reaching younger and deprived populations Uptake was low in those aged <40 years and among disadvantaged residents Not effective in increasing Gold (2000) Adelaide, South ; ; post Medically at risk (children with a previous history of an adverse event following immunisation [AEFI]) 970 children Vaccination clinic for children with history of AEFI Vaccination 90% Achieved high Sample may not be representative of the population Unknown comparators (i.e. population rate of AEFI) Summary of strategies to increase vaccination uptake in Page 7 of 13

8 Sample size Intervention(s) Outcomes onclusion Limitations Grant (2005) R Sunshine oast, Queensland + pneumococcal + adult diphtheriatetanus (ADT) + hepatitis B + MMR h + influenza 1,344 (20% of the Indigenous population in the Health Service District) Mass vaccination clinics (public places) + home visits Number of people vaccinated Before the program = 332 After = 1,344 Intervention activities changed over time measurement of outcomes challenging All Aboriginal and Torres Strait Islander persons Howe (2009) R Western post HWs 399 General Practice Network staff Free vaccine Vaccination 54% vaccinated, of which 34% had not received the vaccine previously Lack information on intention to vaccinate pre-intervention Macdonald (2007) (cohort) Behaviourally at risk ( high risk patient attending sexual health centre) 2,085 patients Accelerated vaccination schedule Vaccination 2 doses Standard schedule = 45% Accelerated schedule = 50% 3 doses Standard schedule = 16% Accelerated schedule = 22% Some increase in Impact of other aspects of service delivery on not evaluated Source of intention to vaccinate unknown Piper Tweed Heads, New South Wales post Aboriginal and Torres Strait Islander children 7 years of age 276 children Reminder letters sent + personalised followup if no response Vaccination 34% completed 46% currently completing 0.5% conscientious objectors 93% up to date with scheduled vaccinations Reeve Mt Isa, Queensland post Human papillomavirus (HPV) Adolescents (10 13 years) 304 students School-based vaccination program delivered by GPs onsent form return rate = 94% onsent rate = 90% Vaccine uptake dose 1 = 89% dose 2 = 88% dose 3 = 79% Achieved high No formal evaluation activities undertaken Summary of strategies to increase vaccination uptake in Page 8 of 13

9 Sample size Intervention(s) Outcomes onclusion Limitations Ressler (cohort) hildren 539 children Hospital-based catchup plan Vaccination within a time-frame hildren with catch-up plan sig. more likely to be vaccinated within 30 days of admission (p=0.005) and within 90 days (p=0.04) compared to those without catchup plan Improved timeliness of catch-up immunisation Recall bias by use of retrospective data Reasons for delayed vaccination not given Rogers (2005) post Behaviourally at risk (injecting drug users) 90 injecting drug users Accelerated vaccination schedule + personalised reminders Vaccination 3 doses = 71% 2 doses = 11% 1 dose = 18% Achieved moderate by use of retrospective data Measurement deficit seroprotection data Smith Albury, New hildren Not stated Mass vaccination clinics (library setting) + promotional material Vaccination and attendance records Two clinics run with total of 29 children attending (average in routine clinics = 6 8) Study did not detect temporal associations onfounding Vaccination increased by 14% in 6 months SESIAHS R Wollongong and Illawarra area, New Adult and childhood vaccines Medically at risk (refugees) 123 newly arrived refugees Hospital and general practice collaborative care model + staff education onsultation All 64 (100%) children and 59 (95%) adults were seen by GPs and had recommended screening tests 55% of children were underimmunised and received catch-up vaccines Improved provision of immunisation by GPs Summary of strategies to increase vaccination uptake in Page 9 of 13

10 Provider-based interventions (n=8) Primary (year)a Sample size Intervention(s) Outcomes onclusion Limitations Ali (2009) hildren 42 general practices Provider education + support at the general practice Vaccination Proportion of general practices with >90% increased from 30% to 68% olgrave Routine vaccinations for n Defence Force personnel dtpa g, polio, hepatitis A, hepatitis B, typhoid, MMR h, varicella 800 patients at the Tobruk Lines Health entre An audit of an electronic patient management database to determine vaccination currency of patients and accuracy of vaccination records % due at least one vaccination = 9.75% Most commonly due vaccine = typhoid (n=73/94) The audit reduced the proportion of overdue vaccinations by 42% and increased by 2%. and awareness of those who were due for routine vaccination Audit only included those due/overdue for vaccination. It is possible that the electronic vaccination records of up to date patients are erroneous thus artificially inflating. Occupationally at risk (n Defence Force personnel) Finlay Albury, New Older people 12 aged care facility staff 630 residents Staff education + promotional materials Vaccination of residents 2007 = 87.5% 2008 = 92% None identified Frank (2004) Adelaide, South Quasi-RT e (non-blinded) Tetanuscontaining vaccine + MMR h + influenza + pneumococcal Adults 10,507 adults Intervention = 5,118 ontrol = 5,389 Provider reminders % increase in vaccination Tetanus = 2.8% (p<0.05) Pneumococcal = 2.8% (p<0.05) MMR = 10.3% (p>0.05) = 26.2% (p>0.05) Significantly increased None identified Irwin (2002) + pneumococcal Medically at risk (children with at risk conditions) Not stated Reminders (hospital based) + staff education Provision of vaccines = 2.5% Pneumococcal = 3.4% provision of vaccines None identified Summary of strategies to increase vaccination uptake in Page 10 of 13

11 (year)a Sample size Intervention(s) Outcomes onclusion Limitations Kerse (1999) (RT e ) Older people 42 GPs Intervention = 21 ontrol = 21 Patients = 267 Education (for GPs) + provider reminders Vaccination of patients from 66% to 73% (p=0.14) Significantly increased Selection bias Lake Adelaide, South post HWs 26 residential aged care facilities (RAFs) 10 RAFs participated Staff training + policy (standing orders for nurses) + free vaccine Vaccination Residents = 80% Staff = 41% Vaccine provision also increased in participating RAFs No use of comparator MacIntyre (2003) RT e ) + pneumococcal Older people 131 elderly Intervention = 70 ontrol = 61 Reminders for hospital staff vs GPs Vaccination Intervention = 63% ontrol = 53% Pneumococcal Intervention = 67% ontrol = 55% No significant differences between reminder systems both increased uptake Selection bias Lack of Insufficient power to detect differences in effect Summary of strategies to increase vaccination uptake in Page 11 of 13

12 Regulatory interventions (n=6) Primary Sample size Intervention(s) Outcomes onclusion Limitations Bond (2002) sectional) hildren 1997 = 1, = 1,793 National policy maternity immunisation allowance (MIA) + child care benefit (B) Vaccination from 84% to 93% Study design not sufficient to detect temporal associations onnors (1998) Darwin, Northern Territory (0, 2, 6 months schedule) Newborns 1993 = 2, = 2,111 urisdictional policy vaccination of infants born after August 1990 Vaccination in hospitals 1993 Hos A: 96%; Hos B: 71% 1994 Hos A: 93%; Hos B: 77% Some increase in Helms (2011) New South Wales post dtpa g + MMR h + varicella + hepatitis B HWs 58 HWs and executive staff (qualitative interviews) urisdictional policy mandatory vaccination against specified diseases for HWs Full compliance = 39 73% Number of unprotected staff reassigned or risk managed = 0 3 Proportion of students rejected for failure of compliance = 0 8% Increases in following this policy have been modest and difficult to quantify Absence of baseline data prior to policy implementation No health region/service(s) completed implementation by target date (Dec 2008) Lam (1998) sectional) Newborns 678 students urisdictional policy vaccination of neonates born to hepatitis B virus (HBV) carrier mothers Self-reported vaccination rates Born before program = 31% Born after program = 68% Smithers (2003) dtpa g + hepatitis B + OPV i + varicella + influenza + MMR h + BG j HWs 287 HWs Hospital HWs vaccination policy + part-time immunisation coordinator at the hospital Vaccination Fully vaccinated: baseline = 19% vs follow-up = 24% (non-sig.) Vaccines with significant increases in : (baseline; follow-up) OPV: 82%; 86% booster: 25%; 33% BG: 62%; 76% Recall bias Potential data contamination Summary of strategies to increase vaccination uptake in Page 12 of 13

13 Sample size Intervention(s) Outcomes onclusion Limitations Stewart (2002) dtpa g + hepatitis B + OPV i + varicella + influenza + MMR h + BG j HWs Baseline = 308 Follow-up = 209 Hospital HWs vaccination policy Vaccination New HWs were significantly less likely to be immunised against hepatitis B No other significant differences with respect to vaccination No increase in Sample size lower at follow-up Potential overestimation of effects Recall bias Insufficient time to observe effects a. = ournal = onference abstract R = Report b. design as described in the article is classified according to Irwig and umming study types in population health research (Irwig and umming, 1988) c. overage measured in the same target group before and after the intervention d. Vaccines recommended on the n National Immunisation Program for children under the age of 7 years e. Randomised control trial f. overage measured in the same target group following the intervention only g. Diphtheria-tetanus-acellular pertussis vaccine (dtpa = reduced antigen content vaccine; DTPa-IPV = DTPa and inactivated polio virus (IPV) combination vaccine h. Measles-mumps-rubella vaccine i. Oral polio vaccine j. Bacille almette-guérin vaccine omplete findings from this systematic review available in Ward K, how MYK, King, Leask. Strategies to improve vaccination uptake in, a systematic review of types and effectiveness. n and New Zealand ournal of Public Health 2012; 36(4): doi /j x. Summary of strategies to increase vaccination uptake in Page 13 of 13