Table: Included studies featuring facilitated relay of clinical information to clinicians

Study/Author / Study design / Study population / Setting / Intervention summary / Vaccination outcomes / Vaccination results / Study conclusions / Quality score
Fishbein et al. 2006 {{8827}} / Design: CBA
Group allocation: Patients were allocated in consecutive blocks to treatment and control groups.
Follow-up period: 1 year / Number of patients: 600*
Group 1
Number of patients: 300*
Female (%): 70%
Age (mean(sd)): 48 (sd not reported)
Control group
Number of patients: 300*
Female (%): 66%
Age (mean(sd)): 47 (sd not reported.
Eligibility criteria: Patients aged 18 years or older, not acutely ill, providing written consent. Influenza and pneumococcal vaccinations were recommended for patients aged 65 years or older, or those with select chronic diseases.
* Includes patients for whom influenza and pneumococcal vaccinations were not indicated. / Number of sites: 3 family practice sites
Site affiliation: 1 academic site, 1 private practice, and 1 primary health centre
Number of practices or physicians: 16 physicians
Location: United States (Louisiana, New Mexico, and Georgia) / Patient self-assessment / provider reminder tool vs usual care
Intervention aim: Improve vaccination rates
QI agent: Medical clinics
Group 1
Facillitated relay of patient information: Patient completed a paper-based self assessment/ provider reminder (A/R) tool. The tool is comprised of a series of yes/no questions that assess patients’ needs for 8 immunizations (reduced to 6 at two of three study sites).
Clinician reminders: The A/R tool prompted clinicians to provide recommended vaccinations. The A/R tool also remained part of the patient chart after the initial visit at which it was produced.
Patient education: The A/R tool was accompanied by educational material concerning recommended vaccinations.
Control group
Usual care. Patients received information on physical activity instead of the A/R tool. / Influenza
Proportion of eligible patients receiving vaccination
Odds ratio of receiving vaccination between treatment and control groups
Pneumococcal
Proportion of eligible patients receiving vaccination
Odds ratio of receiving vaccination between treatment and control groups / Influenza
Baseline*
Group 1: 56/175 (32%)
Control: 38/165 (23%)
Follow-up – Vaccination during the day the A/R tool was provided **
Group 1: 25/119 (21%)
Control: 31/127 (24%)
Follow-up – 1 year after the A/R tool was provided**
Group 1: 24/94 (26%)
Control: 30/96 (31%)
Follow-up – Vaccination during the day the A/R tool was provided**
OR = 0.82
P = 0.57
Follow-up – 1 year after the A/R tool was provided**
OR = 0.75
P = 0.42
Pneumococcal
Baseline*
Group 1: 45/105 (43%)
Control: 53/112 (47%)
Follow-up – Vaccination during the day the A/R tool was provided**
Group 1: 23/60 (38%)
Control: 8/59 (14%)
Follow-up – 1 year after the A/R tool was provided**
Group 1: 5/37 (14%)
Control: 7/51 (14%)
Follow-up – Vaccination during the day the A/R tool was provided**
OR = 3.96
P = 0.003
Follow-up – 1 year after the A/R tool was provided**
OR – 0.98
P = 1.00
*, ** - See next column, at right. / Administering the A/R tool increased the proportion of same-day vaccinations for influenza at 2/3 study sites, and increased the proportion of same-day pneumococcal vaccinations at 1/3 study sites. Comparing intervention and control patients all together, the intervention improved same-day pneumococcal vaccinations. No significant difference in vaccination uptake during the period after the A/R tool was administered was observed.
Disappointing results may have been due to the large number of vaccinations (8) prompted by the A/R tool. Providers flatly stated that they were not willing, or did not have the time, to consider all eight vaccinations. Authors also suggest that the A/R tool would have become lost among other papers in the patient chart after the initial visit.
* Baseline results refer to those patients who had already been vaccinated that season (influenza) or previously (pneumococcal). These patients were removed from the denominator of successive outcome proportions. Baseline proportions do not represent previous years’ vaccination status.
** Results differed among intervention sites. Overall results extracted here. / 18
Harari et al. 2008 {{12176}} / Design:
RCT
Group allocation:
Experimental study, with patients randomly allocated to treatment or control groups. Patients from the same household were allocated to the same group.
Follow-up period: 1 year / Number of patients: 2503
(2006 patients were available for analysis, enumerated below.)
Group 1
Number of patients: 940
Female/male: 526/414
Age (mean(sd)): 74.7(6.3)
Control group
Number of patients: 1066
Female/male: 564/502
Age (mean(sd)): 74.2 (6.0)
Eligibility criteria:
Patients aged 65 years or older. Patients were excluded if they were nursing home residents, required help with activities of daily living, had dementia, had a terminal illness, or could not speak English. / Number of sites: 3 computerized GP practices
Site affiliation: Private practices
Number of practices or physicians: 18 general practitioners *
Location: United Kingdom (London)
* Outcomes were measured at an additional, non-participating GP group practice with 8 practitioners to check for contamination. / Comprehensive patient health risk survey leading to computer generated patient and GP feedback vs usual care
Intervention aim: Improve preventive care
QI agent: Medical clinics
Group 1
Patient education / reminders: Patients were mailed a questionnaire (HRA-O) comprised of sections on health behavior, preventive care uptake, and self-reported health. Based on questionnaire results, patients were mailed individualized advice on modifying health risks, a preventive health checklists, sources of support, and other information. The 20-35 page individualized report was accompanied by a letter from the patient’s practice, asking patients to discuss issues with their GP or practice nurse. Non-responders were issued a reminder card 6 months later.
Facilitated relay of clinical information: Information from the patient questionnaire was forwarded to GPs, who selected relevant data elements for entry into the patient’s EMR.
Clinician reminders: The EMR was programmed to issue electronic prompts when the patient record was accessed, based on the health risks detected in the patient survey.
Clinician education: GPs and practice nurses participated in training and review sessions on current preventive care and health behavior recommendations.
Control group
Clinician education: GPs and practice nurses participated in training and review sessions on current preventive care and health behavior recommendations. / Influenza
Proportion of eligible patients receiving vaccination
Odds ratio of receiving vaccination between treatment and control groups
Pneumococcal
Proportion of eligible patients receiving vaccination
Odds ratio of receiving vaccination between treatment and control groups / Influenza
Follow-up
Group 1: 788/939 (84%)
Control: 916/1066 (86%)
Non-participating site: 65%
Follow-up
Group 1 vs control
OR = 0.8
P = 0.12
Group 1 vs non-participating site
P < 0.0001
Pneumococcal
Follow-up
Group 1: 308/939 (33%)
Control: 291/1066 (28%)
Follow-up
Group 1 vs control
OR = 1.2
P = 0.04
Group 1 vs non-participating site
P = non-significant / Integration of an evidence-based delivery instrument (HRA-O) for the promotion of health in older people into the current IT driven system of three British primary care group practice did not improve self-reported health risk variables over 12 months, other than increased pneumococcal vaccination take-up.
The authors suggest that contamination may have obscured the intervention effect, since all health care workers received preventive care education. This explanation is supported by much lower vaccination rates in the non-participating practice.
Supplementary reinforcement involving direct professional/patient follow-up contact may be necessary to achieve benefit. / 20