Since 1964 the Advisory Committee on Immunization Practices of the US Public Health Service has recommended influenza vaccination of high-risk individuals, including older people. It is important to determine which interventions are most effective in increasing vaccination in those aged 60 and older.
Interventions reviewed were categorized as those to increase community demand (patient reminders, personalized reminders, education and vaccination of patients); increase access (group visits, home visits, the provision of free vaccinations) and provider/system-based interventions (physician reminders, posters, the use of facilitators in physician practices, physician education/feedback, and financial incentives to physicians). A fourth category of interventions are society-level. Although no randomized controlled trials were found, this category would include government policies and mandated programs such as paying healthcare workers to achieve specific vaccination targets.
All the identified randomized controlled trials (RCTs) were of older people in the community, and in high-income countries. We did not find any includable RCTs of interventions to increase rates in institutions. Only 11 of 44 RCTs were at low or moderate risk of bias. They included three of the 13 personalized postcard/phone call interventions (all three effective), two of the four home visit interventions (both effective, but one small and with imbalances in the study arms), three of the four reminders to physicians interventions (none effective), and three of the four facilitator interventions (two effective). The other 33 RCTs were at high risk of bias, and the limited results of the RCTs at low and moderate risk of bias should be viewed in this context.