Balzarini Federica, Frascella Beatrice, Oradini-Alacreu Aurea, Gaetti Giovanni, Lopalco Pier Luigi, Edelstein Michael, Azzopardi-Muscat Natasha, Signorelli Carlo, Odone Anna
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Department of Translational Research, New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy.
Vaccine. 2020 Aug 27;38(38):5966-5978. doi: 10.1016/j.vaccine.2020.05.083. Epub 2020 Jun 30.
Although Personal Electronic Health Records (PEHR) have been identified as innovative tools enabling the provision of patient-centered care and prevention, evidence on the impact of their use is scant. With PEHRs being more and more marketed as easily implementable and cost-effective instruments to provide people with direct control on their health, the question on whether their use might be associated with the priority to improve vaccine coverage arises.
We conducted a systematic review following the PRISMA guidelines to retrieve, quantitatively pool and critically appraise the effectiveness of PEHR access on vaccine uptake. Analysis on PEHR effectiveness were carried out for the following comparison strata: i) PEHR access vs no intervention (standard care, no access to PEHR), ii) PEHR access only vs access to PEHR with additional features (e.g. health education materials, active reminders).
Of 3114 identified citations, 8 studies were included, the majority published in the US and before 2015; 62% were randomized trials, the rest having an observational study design. Evidence suggests a moderate positive impact of PEHR access in increasing vaccine uptake, with data available for influenza and pneumococcal vaccines, diabetic patients and childhood immunization. Pooled data report the addition of digital communication features, i.e. the delivery of educational messages, reminders and availability of scheduling features might increase vaccine uptake, as compared to PEHR access alone. However, evidence is not conclusive.
While immunization programs are struggling to achieve optimal coverage targets, it seems the potential of PEHRSs supporting informed adherence to vaccines recommendations is neither fully exploited nor explored. Which factors mediate the association between PEHRs access and vaccine uptake? Which PEHRs' design and functional components can maximize their impact? On which target populations? Which PEHR models works better for high-risk populations? Our findings can only partially answer those questions and further experimental research is needed.
尽管个人电子健康记录（PEHR）已被视为有助于提供以患者为中心的护理和预防的创新工具，但关于其使用影响的证据却很少。随着PEHR越来越多地作为易于实施且具有成本效益的工具进行推广，旨在让人们直接掌控自身健康，其使用是否可能与提高疫苗接种率的优先事项相关这一问题也随之出现。
我们按照PRISMA指南进行了一项系统综述，以检索、定量汇总并严格评估获取PEHR对疫苗接种率的有效性。针对以下比较层次对PEHR的有效性进行了分析：i）获取PEHR与无干预（标准护理，无法获取PEHR），ii）仅获取PEHR与获取具有附加功能（如健康教育材料、主动提醒）的PEHR。
在3114条检索到的文献中，纳入了8项研究，其中大多数发表于美国且在2015年之前；62%为随机试验，其余为观察性研究设计。有证据表明，获取PEHR对提高疫苗接种率有适度的积极影响，现有关于流感疫苗、肺炎球菌疫苗、糖尿病患者和儿童免疫接种的数据。汇总数据表明，与仅获取PEHR相比，增加数字通信功能，即提供教育信息、提醒以及具备预约功能，可能会提高疫苗接种率。然而，证据并不确凿。
尽管免疫规划正努力实现最佳接种率目标，但支持明智地遵循疫苗接种建议的PEHR的潜力似乎既未得到充分利用，也未得到充分探索。哪些因素介导了获取PEHR与疫苗接种率之间的关联？PEHR的哪些设计和功能组件能够使其影响最大化？针对哪些目标人群？哪种PEHR模式对高危人群效果更佳？我们的研究结果只能部分回答这些问题，还需要进一步的实验研究。
