Interventions in primary care to increase uptake of adult vaccines: a systematic review

Background There is a significant gap in understanding which strategies effectively enhance vaccination rates for recommended adult vaccines in primary care settings. This review aimed to identify interventions in outpatient clinics that increase vaccination rates for commonly recommended adult vaccines and describe the change in vaccination rate associated with each intervention aimed at increasing vaccination rates in adults.Methods Systematic searches identified randomized, controlled trials aiming to increase the rate of vaccination in adults in outpatient clinics. Following PRISMA guidelines, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Two reviewers independently extracted relevant data and assessed risk of bias. Meta-analysis was not done due to heterogeneity of data.Results Forty-four RCTs met inclusion criteria. Clinician reminders to order vaccine increased vaccination 4%-32%. Electronic health record (EHR) prompts to patients or physicians increased vaccination 1%-16%. Bundled interventions increased vaccination 4%-42%, with more intensive interventions associated with higher increases. RCT of interventions involving face-to-face contact with patients increased vaccinations 6%-17%. Group outpatient visits increased vaccination 13%-17%, home visits 6%-17%, and physician or nurse recommendation 15%.Conclusions Clinics may increase vaccination rates by reminding doctors to order vaccine, promoting face-to-face conversations about vaccination, and instituting bundled clinic process improvements. EHR prompts may be less effective.