Vaccination Programs: Home Visits to Increase Vaccination Rates

Community Preventive Services Taskforce Task Force Finding and Rationale Statement (2016)

The Community Guide - N/A

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Evidence Categories

• Care setting: Primary care
• Population group: Older adults
• Intervention: Health literacy
• Intervention: Improving access
• Outcome: Uptake of vaccinations

Type of Evidence

Systematic Review

Aims

"This report aimed to determine whether home visits increase vaccination rates in children and adults."

Findings

The authors state:

"The finding is based on evidence from a Community Guide systematic review completed in 2009 (19 studies, search period 1980-2009) combined with more recent evidence (4 studies, search period 2009-2012).

The systematic review included 23 studies. Of these, 20 studies with 21 study arms used a common measure of change in vaccination rates.

• Overall vaccination rates increased by a median of 11 percentage points (20 studies with 21 study arms).
• Home visits led to meaningful improvements in vaccination rates when used in the following ways:
  • With all clients in a designated population (12 study arms)
  • With only clients who did not respond to other interventions (9 study arms)
  • When focused on vaccinations alone (12 study arms)
  • When used to address vaccinations and other health concerns (9 study arms)
  • When vaccinations were provided on-site (8 study arms)
  • When clients were referred to vaccination services outside the home (13 study arms)
  • As the sole intervention (8 study arms)
  • As part of a larger healthcare system or community-based program (13 study arms)

Findings from the economic review show that home visits are resource-intensive and high-cost interventions relative to other available options.

Nine studies were included in the review (search period: 1980 – 2012). Monetary values are in reported in 2013 US dollars.

• The median for intervention group size was 575 (9 studies)
• Median cost per person was $56.30 (9 studies)
• Median cost per additional vaccinated person was $786.79 (9 studies)
• Studies were conducted in the United States (5 studies), the United Kingdom (2 studies), Australia (1 study), and Canada (1 study).
• One study looked at adolescent vaccines; eight studies evaluated interventions focused on the childhood vaccination series."

Conclusions

The authors state:

"The Community Preventive Services Task Force recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates. The Task Force notes, however, the economic evidence showing that home visits can be resource-intensive and costly relative to other options for increasing vaccination rates. Evidence on effectiveness was considered strong based on a body of evidence that included studies of home visits delivered to all clients or to those unresponsive to other interventions, home visits focused on vaccination alone or in combination with other health concerns, and home visits that provided vaccinations on-site or referred clients to vaccination services outside the home."