Sylwer fod y cymhwysiad hwn dan ddatblygiad. Os ydych chi'n gweld unrhyw gamgymeriadau neu os nad yw rhywbeth yn gweithio, cysylltwch â ni yn evidence.service@wales.nhs.uk.
Adolygiad Systematig
The CPSTF recommends coordinated vaccination interventions in women, infants and children (WIC) settings based on strong evidence of effectiveness in increasing vaccination rates in children. Evidence on effectiveness was considered strong based on studies in which assessment of client immunization status and referral to vaccination providers was combined with: 1) provision of vaccinations on-site or in a collocated healthcare facility, or 2) additional interventions such as monthly voucher pickup requirements, manual tracking and outreach, or client reminder and recall systems. Evidence was limited regarding the effectiveness of assessment and referral in WIC settings when implemented alone.
The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (15 studies, search period January 1980-November 2009). A more recent search for evidence (search period 2009-February 2012) did not identify any new studies to be included in the systematic review.
The combined evidence included 15 studies of programs that coordinated assessment and referral in WIC settings with additional interventions. Only one study evaluated the use of assessment and referral programs when used alone and found no effect. Of the included studies, 8 (10 study arms) provided a common measurement of change in vaccination rates and observed a median increase of 10.5 percentage points (IQI: 4 to 19 percentage points).
The most common additional interventions were monthly voucher pickup (5 studies) and provision of vaccinations onsite or in collocated healthcare facilities (4 studies).
All of the included studies evaluated WIC programs in urban settings and populations. Despite the lack of evidence from suburban and rural settings, the Task Force considers the overall evidence on effectiveness to be applicable in most WIC settings and populations.
This CPSTF report concludes that WIC services provide opportunities for regular and ongoing contact with families who may have limited access or substantial barriers to immunization services. Although on-site or collocation of vaccination services can substantially enhance access, these approaches require ongoing communication and coordination between WIC programs and healthcare providers in order to minimize missed vaccination opportunities while maintaining continuity of care.
Only one study examined vaccination status assessment and referral when implemented alone. Additional studies are needed to determine the effectiveness of this basic approach. More research is needed on efforts to collocate WIC and health care services, on the adoption of monthly voucher pickup requirements, and on the impact of providing WIC interventions outside of the medical home.