From: Vaccination in England: a review of why business as usual is not enough to maintain coverage
First Author, year [reference] | Sample from population | Design | Vaccine | Intervention category | Intervention | Sample and comparison | Effect measure | Risk of bias |
---|---|---|---|---|---|---|---|---|
Le Menach, 2014 [60] | Children aged 6 months – 16 years from one general practice. | B&A | MMR | Multi-component | Campaign offering accelerated vaccination (6-11 months), early 2nd dose (6-11 months) and catch up vaccinations. | Coverage in 1538 children measured before and after campaign. | Increase in proportion of >14 months immunised by 3% (to 71%) and of >60 months by 5% (to 65%) following the campaign. | Low (assessors not blinded; unclear consideration of group effects) |
Cockman, 2011 [61] | All children in the London Borough of Tower Hamlets. | Eco | MMR | Multi-component | Quality improvement project associated with campaign including: incentive payments; practice network; commissioning care package; new targets; IT for reminder/recall; active follow-up defaulters. | Coverage in all children in the area measured over time. | Coverage of MMR1 increased from 80% before the intervention to 94% after. Significant difference (p=0.001) in slope of coverage change pre (-0.07% per quarter) and post (1.86% per quarter). | Low (assessors not blinded; unclear consideration of group effects) |
Siriwardena, 2003 [57] | Selected general practices from all practices in Lincolnshire. | B&A | Influenza & pneumococcal | Multi-component | Dissemination of clinical guidelines; advise on data and surveillance; organisational strategy; reminder/recall; comparative performance. | Coverage in 21 general practices before and after participating in project. | Significant increases in coverage before and after for both influenza and pneumococcal in a range of groups e.g. pneumococcal in CHD 27.5% increase (CI 12.6-42.3%; p=0.002) | Moderate (general objective; diffuse intervention; assessors not blinded; no consideration of group effects) |
McDonald, 1997 [66] | Eligible patients in risk groups registered at general practices in Tameside. | B&A | Pneumococcal | Multi-component | Improved vaccine supply; clinical guidelines; patient materials; patient information leaflet translations; education. | Proportion of eligible patients immunised at participating practices before and after the intervention. | Increase in coverage from 6% before to 33% after the campaign. | Moderate (eligibility and selection unclear; diffuse intervention; assessors not blinded; no consideration of group effects) |
MacDonald, 2016 [62] | Unimmunised children from Dudley local health area. | Eco ITS | MMR | Outreach | Immunisation offered during home visits | Comparison of coverage in local population using quarterly routine data. | Intervention contributed 2.6% of the MMR doses given during the study period. | High (enrolment and sample size unclear; assessors not blinded; limited statistical consideration) |
Atchison, 2013 [63] | General practices in Wandsworth, London. | B&A | Childhood schedule | Reminder/recall | Standardised reminder/recall system involving letters and referral to health visitors. | 32 participating practices compared to 44 not participating before and after the intervention. | Significant increase in coverage in intervention group, but as a result of unexplained decreases in control group coverage. | Moderate (likely differences between intervention and control practices; assessors not blinded; no consideration of group effects). |
Henderson, 2004 [64] | General practices in Highland NHS Health Board area. | Eco | Childhood schedule | Reminder/ recall | Participation in national reminder/recall system vs. use of general practices’ own system. | Coverage between 8 practices using their own reminder/recall system vs. 66 participating in a national system. | Higher coverage in national system practices of diphtheria by age 2 (6.4%, CI 1.7-11.1, p=0.001) and Men C by age 2 (7.6%, 2.7-13%, p=0.001) but no difference for diphtheria by 1 year or MMR by 2 years. | Moderate (natural experiment – intervention dose unclear; likely difference between intervention and control practices; assessors not blinded; group effects not considered) |
Gosden, 2003 [65] | Selected general practices in England. | B&A | Childhood schedule | Incentive | General practice contracting arrangements: GMS vs. PMS contracts. | Coverage in 10 practices who had switched to PMS contract vs. matched 10 control practices on GMS contract. | No difference in immunisation coverage between practices (-1.08%, CI -17.95-15.8%) | Moderate (natural experiment – intervention dose unclear; likely difference between intervention and control practices; unclear if large enough sample; assessors not blinded; group effects not considered) |
Norbury, 2011 [8] | 315 general practices in Scotland | Eco B&A | Influenza in >65-year olds and risk groups | Incentive | QOF | Coverage in >65 yo and risk groups before (03-04) vs. after (06-07) introduction on QOF incentive in 2004. | Increase in coverage by 3.5% (CI 3.3 to 3.7%); higher in <65 yo 8.8% (CI 8.3 to 9.4%) than >65 yo 3.3% (CI 3.1 to 3.6%). Higher increases in those with disease risk, than age alone. | Low (no blinding of assessors) |
Kontopantelis, 2012 [68] | All practices in England. | Eco CB&A | Influenza in people with CHD | Incentive | QOF | Coverage before vs. after the increase in upper payment threshold from 85% to 90% in 2006; and vs. other risk groups with no threshold change. | Immediate increase of 0.41% (CI 0.25 – 0.56%) population coverage, with larger increase seen in practices with <85% in 2006 of 0.85% (0.62 – 10.08%) | Low (no blinding of assessors) |
Kontopantelis, 2014 [69] | Patients at 50 representative practices from 644 in CPRD | Eco ITS | Influenza in people with asthma | Incentive | QOF | Coverage before vs. after QOF target removed in 2006. | Small drop in coverage -0.70% (CI -1.1% to -0.39% | Low (no blinding of assessors) |