Increasing Appropriate Vaccination: Standing Orders

Community Preventive Services Taskforce Task Force Finding and Rationale Statement (2015)

The Community Guide - N/A

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Evidence Categories

• Care setting: Secondary Care
• Care setting: Supported living/care homes
• Care setting: Primary care
• Population group: Adults
• Intervention: Other Intervention
• Outcome: Uptake of vaccinations
• Outcome: Cost effectiveness

Type of Evidence

Systematic Review

Aims

"This report aimed to determine whether standing orders for vaccinations when used alone or when combined with additional interventions increase vaccination rates among adults and children from different populations or settings."

Findings

The authors state:

"The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. The Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (interquartile interval [IQI]: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results.

Three U.S. studies that evaluated the economics of standing orders for pneumococcal, influenza, and Tdap vaccines were included in the economic review (search period 1980–2012). All monetary values are reported in 2013 U.S. dollars. Intervention groups had a median size of 11,813 clients (IQI: 1068 to 24,266, 3 studies). The median cost per person per year to implement the intervention was $5.55 (IQI: $5 to $13, 3 studies), and the median cost per additional vaccinated person was $29 (IQI: $18 to $63, 3 studies)."

Conclusions

The authors state:

"The Community Preventive Services Task Force recommends standing orders for vaccinations on the basis of strong evidence of effectiveness in increasing vaccination rates among adults and children; when used alone or with additional interventions; and across a range of settings and populations."