Thomas Roger E, Lorenzetti Diane L
Department of Family Medicine, Faculty of Medicine, University of Calgary, UCMC, #1707-1632 14th Avenue, Calgary, AB, Canada, T2M 1N7.
Cochrane Database Syst Rev. 2014 Jul 7;2014(7):CD005188. doi: 10.1002/14651858.CD005188.pub3.
The effectiveness of interventions to increase the uptake of influenza vaccination in people aged 60 and older is uncertain.
To assess access, provider, system and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.
We searched CENTRAL (2014, Issue 5), MEDLINE (January 1950 to May week 3 2014), EMBASE (1980 to June 2014), AgeLine (1978 to 4 June 2014), ERIC (1965 to June 2014) and CINAHL (1982 to June 2014).
Randomised controlled trials (RCTs) of interventions to increase influenza vaccination uptake in people aged 60 and older.
Two review authors independently assessed study quality and extracted influenza vaccine uptake data.
This update identified 13 new RCTs; the review now includes a total of 57 RCTs with 896,531 participants. The trials included community-dwelling seniors in high-income countries. Heterogeneity limited meta-analysis. The percentage of trials with low risk of bias for each domain was as follows: randomisation (33%); allocation concealment (11%); blinding (44%); missing data (49%) and selective reporting (100%). Increasing community demand (32 trials, 10 strategies)The interventions with a statistically significant result were: three trials (n = 64,200) of letter plus leaflet/postcard compared to letter (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15); two trials (n = 614) of nurses/pharmacists educating plus vaccinating patients (OR 3.29, 95% CI 1.91 to 5.66); single trials of a phone call from a senior (n = 193) (OR 3.33, 95% CI 1.79 to 6.22), a telephone invitation versus clinic drop-in (n = 243) (OR 2.72, 95% CI 1.55 to 4.76), a free groceries lottery (n = 291) (OR 1.04, 95% CI 0.62 to 1.76) and nurses educating and vaccinating patients (n = 485) (OR 152.95, 95% CI 9.39 to 2490.67).We did not pool the following trials due to considerable heterogeneity: postcard/letter/pamphlets (16 trials, n = 592,165); tailored communications (16 trials, n = 388,164); customised letter/phone-call (four trials, n = 82,465) and client-based appraisals (three trials, n = 4016), although several trials showed the interventions were effective. Enhancing vaccination access (10 trials, six strategies)The interventions with a statistically significant result were: two trials (n = 2112) of home visits compared to clinic invitation (OR 1.30, 95% CI 1.05 to 1.61); two trials (n = 2251) of free vaccine (OR 2.36, 95% CI 1.98 to 2.82) and one trial (n = 321) of patient group visits (OR 24.85, 95% CI 1.45 to 425.32). One trial (n = 350) of a home visit plus vaccine encouragement compared to a home visit plus safety advice was non-significant.We did not pool the following trials due to considerable heterogeneity: nurse home visits (two trials, n = 2069) and free vaccine compared to no intervention (two trials, n = 2250). Provider- or system-based interventions (17 trials, 11 strategies)The interventions with a statistically significant result were: two trials (n = 2815) of paying physicians (OR 2.22, 95% CI 1.77 to 2.77); one trial (n = 316) of reminding physicians about all their patients (OR 2.47, 95% CI 1.53 to 3.99); one trial (n = 8376) of posters plus postcards (OR 2.03, 95% CI 1.86 to 2.22); one trial (n = 1360) of chart review/feedback (OR 3.43, 95% CI 2.37 to 4.97) and one trial (n = 27,580) of educational outreach/feedback (OR 0.77, 95% CI 0.72 to 0.81).Trials of posters plus postcards versus posters (n = 5753), academic detailing (n = 1400) and increasing staff vaccination rates (n = 26,432) were non-significant.We did not pool the following trials due to considerable heterogeneity: reminding physicians (four trials, n = 202,264) and practice facilitators (three trials, n = 2183), although several trials showed the interventions were effective. Interventions at the societal level We identified no RCTs of interventions at the societal level.
AUTHORS' CONCLUSIONS: There are interventions that are effective for increasing community demand for vaccination, enhancing access and improving provider/system response. Heterogeneity limited pooling of trials.
提高60岁及以上人群流感疫苗接种率的干预措施效果尚不确定。
评估在社区中提高60岁及以上人群流感疫苗接种率的获取、提供者、系统和社会层面的干预措施。
我们检索了Cochrane系统评价数据库（2014年第5期）、医学期刊数据库（1950年1月至2014年第3周）、荷兰医学文摘数据库（1980年至2014年6月）、老年医学数据库（1978年至2014年6月4日）、教育资源信息中心数据库（1965年至2014年6月）和护理学与健康领域数据库（1982年至2014年6月）。
提高60岁及以上人群流感疫苗接种率的干预措施的随机对照试验。
两名综述作者独立评估研究质量并提取流感疫苗接种数据。
本次更新纳入了13项新的随机对照试验；该综述现共纳入57项随机对照试验，涉及896,531名参与者。试验纳入了高收入国家的社区老年人。异质性限制了荟萃分析。各领域偏倚风险较低的试验所占百分比分别为：随机化（33%）；分配隐藏（11%）；盲法（44%）；数据缺失（49%）和选择性报告（100%）。
增加社区需求（32项试验，10种策略）
三项试验（n = 64,200）比较信件加传单/明信片与信件（比值比（OR）1.11，95%置信区间（CI）1.07至1.15）；两项试验（n = 614）比较护士/药剂师对患者进行教育并接种疫苗（OR 3.29，95% CI 1.91至5.66）；单项试验分别为老年人打电话（n = 193）（OR 3.33，95% CI 1.79至6.22）、电话邀请与门诊预约（n = 243）（OR 2.72，95% CI 1.55至4.76）、免费食品杂货抽奖（n = 291）（OR 1.04，95% CI 0.62至1.76）以及护士对患者进行教育并接种疫苗（n = 485）（OR 152.95，95% CI 9.39至2490.67）。
由于异质性较大，我们未对以下试验进行合并：明信片/信件/宣传册（16项试验，n = 592,165）；针对性沟通（16项试验，n = 388,164）；定制信件/电话（4项试验，n = 82,465）以及基于客户的评估（3项试验，n = 4016），尽管有多项试验表明这些干预措施有效。
增强疫苗接种可及性（10项试验，6种策略）
两项试验（n = 2112）比较家访与门诊邀请（OR 1.30，95% CI 1.05至1.61）；两项试验（n = 2251）比较免费疫苗（OR 2.36，95% CI 1.98至2.82）；一项试验（n = 321）比较患者小组就诊（OR 24.85，95% CI 1.45至425.32）。一项试验（n = 350）比较家访加疫苗鼓励与家访加安全建议，结果无统计学意义。
由于异质性较大，我们未对以下试验进行合并：护士家访（2项试验，n = 2069）以及免费疫苗与无干预措施比较（2项试验，n = 2250）。
基于提供者或系统的干预措施（17项试验，11种策略）
两项试验（n = 2815）比较支付医生费用（OR 2.22，95% CI 1.77至2.77）；一项试验（n = 316）比较提醒医生关注所有患者（OR 2.47，95% CI 1.53至3.99）；一项试验（n = 8376）比较海报加明信片（OR 2.03，95% CI 1.86至2.22）；一项试验（n = 1360）比较图表审查/反馈（OR 3.43，95% CI 2.37至4.97）；一项试验（n = 27,580）比较教育推广/反馈（OR 0.77，95% CI 0.72至0.81）。
海报加明信片与海报比较（n = 5753）、学术推广（n = 1400）以及提高工作人员疫苗接种率（n = 26,432）的试验结果无统计学意义。
由于异质性较大，我们未对以下试验进行合并：提醒医生（4项试验，n = 202,264）以及实践促进者（3项试验，n = 2183），尽管有多项试验表明这些干预措施有效。
社会层面的干预措施
我们未发现社会层面干预措施的随机对照试验。
存在一些干预措施可有效增加社区对疫苗接种的需求、增强可及性并改善提供者/系统的反应。异质性限制了试验的合并。
