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Systematic Review
The CPSTF finds insufficient evidence to determine the effectiveness of client-held paper immunization records in increasing vaccination rates or reducing rates of vaccine preventable disease. Evidence was considered insufficient because of inconsistent findings and variability in the interventions evaluated.
This Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (7 studies, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-February 2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence.
The Task Force considered evidence from 8 studies with 11 study arms. Six studies (nine measurements) provided a common measure of vaccination rates and reported an overall median increase of 5.3 percentage points (IQI: -1.0 to 8.8 percentage points).
Results were considered inconsistent because client-held paper immunization records were used as part of a multicomponent effort and comparison groups received one or more interventions.
Several considerations for implementation were identified in the included studies and broader literature. These include clients'' declining interest over time and low card retention. Healthcare providers also have expressed concerns about time management when using a preventive services checklist.
With the expansion of population-based Immunization Information Systems and the development of on-line and electronic personal health care records, careful evaluation of client-held paper immunization records effectiveness is needed to achieve high levels of vaccination rates in the US population. However, until issues of privacy, security, and quality of electronic records have been resolved, and for clients on the other side of the "digital divide," traditional client-held paper immunization records will continue to be useful. This may be particularly true for some populations, such as clients with limited computer access and adults whose change in employment status is accompanied by a change in providers.
This CPSTF report concludes that paper immunization records maybe useful when they are used consistently—when providers update them and parents keep track of them. Children are more likely to receive recommended vaccinations and avoid being over-vaccinated. This is especially true when children are seen in non-traditional immunization settings, such as emergency departments.
Further research should therefore examine the effectiveness of additional activities to increase the retention and use of client-held paper immunization records for children by their parents or other caregivers.