School of Population Health, University of New South Wales, Sydney, NSW, Australia.
School of Population Health, University of New South Wales, Sydney, NSW, Australia.
Vaccine. 2021 Jan 22;39(4):658-666. doi: 10.1016/j.vaccine.2020.12.042. Epub 2020 Dec 21.
Despite positive steps towards transforming immunisation understanding and practice to better incorporate adults, coverage, especially those at higher risk, is not where it should be. One way to increase uptake is to take advantage of environments outside of primary care which present easy opportunities for vaccination. This study provides a narrative review of hospital-based strategies in acute care settings aimed at improving influenza vaccination rates for adult inpatients.
A search was conducted using Scopus, Embase and PubMed databases for articles reporting on hospital-based interventions aimed at improving influenza vaccination for adults. Studies published in English were included and descriptively analysed.
A total of 31 articles were included. Tested interventions included 7 standing order protocols (SOP); 4 reminders; 4 assessment/administration programs; 1 patient education program; 1 organisational-based program; 7 multi-component strategies and 8 studies comparing SOPs with other strategies. One article was included in both SOPs and reminders categories. Studies were published between 1983 and 2017 and conducted in the USA, Canada, or Australia. 18 studies reported statistical significance. Individually, each type of intervention showed success. SOPs were significantly more effective than other individual interventions, but multi-component interventions (which included an SOP) were more effective than SOPs alone. Three articles reported no significant increase in uptake attributed mainly to patient refusals, even with a strategy involving patient education. Only three studies tested provider-level strategies including hospital campaigns, hospital reward programs and interdepartmental competitions, and showed success.
Hospital-based interventions are an effective means of improving opportunistic inpatient vaccination. Suggestions for future research include organisational or system-based interventions; qualitative review of barriers and enablers to inpatient vaccination programs; and re-examination of outpatient settings for vaccine delivery. Most studies were not randomised or controlled; therefore, we also recommend additional RCT studies to confirm existing findings on individual strategies.
尽管在将免疫理解和实践转变为更好地纳入成年人方面已经采取了积极的措施，但覆盖率，尤其是高风险人群的覆盖率，还没有达到应有的水平。增加接种率的一种方法是利用初级保健以外的环境，这些环境为接种疫苗提供了容易的机会。本研究对旨在提高成年住院患者流感疫苗接种率的急性护理环境中的基于医院的策略进行了叙述性综述。
使用 Scopus、Embase 和 PubMed 数据库搜索报告旨在提高成人流感疫苗接种率的基于医院的干预措施的文章。纳入发表英文的研究，并进行描述性分析。
共纳入 31 篇文章。测试的干预措施包括 7 项标准操作程序（SOP）；4 项提醒；4 项评估/管理方案；1 项患者教育计划；1 项组织基础计划；7 项多组分策略和 8 项比较 SOP 与其他策略的研究。有 1 篇文章同时归入 SOP 和提醒类别。研究发表于 1983 年至 2017 年，在美国、加拿大或澳大利亚进行。18 项研究报告了统计学意义。单独来看，每种干预措施都取得了成功。SOP 明显优于其他单独的干预措施，但多组分干预措施（包括 SOP）比单独的 SOP 更有效。有 3 篇文章报告称，由于患者拒绝接种疫苗，即使采取了包括患者教育在内的策略，接种率也没有显著增加。只有 3 项研究测试了包括医院宣传活动、医院奖励计划和部门间竞赛在内的提供者层面策略，并且取得了成功。
基于医院的干预措施是提高机会性住院患者接种疫苗的有效手段。未来研究的建议包括组织或系统层面的干预措施；对住院患者疫苗接种计划的障碍和促进因素进行定性审查；以及重新审视为疫苗接种提供服务的门诊环境。大多数研究不是随机或对照的；因此，我们还建议进行额外的 RCT 研究，以证实现有关于个别策略的发现。
