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Systematic Review
This report examines home visits to increase vaccination rates in children and adults, leading to a Community Preventive Services Task Force (CPSTF) recommendation on the subject. The CPSTF 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 Task Force considered evidence from 23 studies of home visits, with 20 studies and 21 study arms using a common measure of change in vaccination rates. The overall effect was a median increase of 11 percentage points (IQR: 5 to 15 percentage points). Meaningful improvements were observed as a result of home visits delivered to all clients (12 study arms) and to only those clients unresponsive to other interventions (9 study arms), home visits focused on vaccination alone (12 study arms) and in combination with other health concerns (9 study arms), and home visits providing on-site vaccinations (8 study arms) and referring clients to vaccination services outside the home (13 study arms). Home visits delivered as the sole intervention (8 study arms) and home visits delivered as part of a larger healthcare system or community-based program (13 study arms) also produced meaningful change in vaccination rates.
Effectiveness studies were conducted primarily in urban settings (15 studies) and in lower income populations (10 studies). Increases in rates were comparable for home visits directed at children (15 studies) and adults (7 studies), as well as for influenza (7 studies) and childhood vaccinations (14 studies).
The CPSTF recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates. Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. The Task Force notes that home visiting interventions are potentially effective in addressing a wide range of public health problems and that the focus of this review is the subset of interventions specifically addressing vaccination rates.
The report identified that more research is needed on the effectiveness and economic benefits of home visits to increase vaccination rates among adolescents and in rural settings. Additional economic research is needed to estimate the portion of home visits that can be attributed solely to improving vaccination rates when home visits include other activities and objectives.