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Adolygiad Sylfaenol NICE
Dywed yr awduron:
"This review aimed to identify effective reminder interventions to increase the uptake of routine vaccines. The meta-analyses demonstrated that reminders increase uptake versus control for all subgroups for which there was data.
The committee make the following recommendations:
- that contact details of recipients should be kept up to date in their medical records and that preferred methods of contact should be ascertained and recorded. The qualitative evidence highlighted the importance of language and literacy issues as additional barriers to vaccine uptake. It is therefore useful if literacy issues or language requirements are also stated in the medical records to facilitate effective contact with these individuals, their families and carers (as appropriate).
- that it is important to invite eligible people to be vaccinated in advance of the vaccination due date. The committee noted that most types of reminders were effective at increasing uptake compared to control, including postcards, letters, phone calls, texts, outreach, and combinations of reminders (phone call and mail, autodialer message and letter).
- there was a lot of heterogeneity between the studies but when the results were pooled, reminders from GPs or primary care, regional health authorities and specialist clinics were more effective at increasing vaccine uptake than control.
- there was an absence of evidence for the effectiveness of vaccine reminders for pregnant women but agreed that the same process of invitation, reminder and then additional reminders should apply to pregnant women as to the other groups where there was more evidence. However, women usually have more contact with their midwives during pregnancy than GPs and as a result, they can also receive in person reminders from their midwife during these appointments. The committee agreed that ideally there would be at least one mention of vaccinations at an early stage in the pregnancy followed by discussions nearer 16- weeks into the pregnancy.
-that although many people respond to invitations for vaccination, other do not or fail to attend scheduled clinics or vaccination appointments, and in these cases a reminder is required. The committee recommended that these people should be identified and be sent a reminder.
- if the person still does not respond after being sent a reminder, the committee agreed that there should be an escalating system of contact to remind people about vaccinations that are due. Escalating reminders may involve for example, a phone call from a GP receptionist initially, then a phone call from the practice nurse if needed and finally the GP until the person is vaccinated or declines vaccination.
- in addition to escalation of contact, the committee included the option to take a multidisciplinary approach because involving other healthcare practitioners such as health visitors could increase the number of opportunities for a reminder to be delivered and therefore increase the likelihood of the vaccinations being accepted.
There was little evidence for the effectiveness of provider reminders and although they were effective for vaccinations for people aged 65 years and over the pooled results could not differentiate uptake when provider reminders were used compared to control. However, when the provider reminders were limited to those using electronic medical record there was an increase using the reminders versus control.
The economic evidence identified for reminder interventions was not used directly by the committee to make recommendations, as they agreed that were not sufficiently applicable as to provide reliable evidence (all the studies were from the US and over 20 years old)."
Dywed yr awduron:
"NICE guideline NG218
Evidence review underpinning recommendations 1.1.1, 1.2.8, 1.2.15 to 1.2.17, 1.3.1, 1.3.7 to 1.3.10, 1.3.14 to 1.3.18, 1.3.20 to 1.3.23, 1.3.26 and 1.3.27, 1.3.31 to 1.3.33 and 1.3.39 in the NICE guideline."