Impact of standing orders on vaccine uptake: A systematic review

OBJECTIVE: We sought to evaluate the impact of standing orders on vaccine coverage in clinical settings. METHODS: Two reviewers independently screened and included studies that evaluated use of standing orders either alone or in combination with other interventions and collected data on vaccine coverage. We extracted effect sizes for studies that used only standing orders as an intervention and had a comparison group. RESULTS: The search yielded 56 eligible studies, 22 of which evaluated standing orders-only interventions. Standing orders increased vaccine uptake by a median of 13 percentage points (IQR 2-20 percentage points). Eight of these studies had a comparison group including 1 randomized trial; 5 were at low risk of bias. The overall findings were similar those for seasonal influenza vaccine (median increase of 12 percentage points; IQR, 6-24; 7 studies) and pneumococcal vaccines (14 percentage points; 2-20; 5 studies), the two most studied outcomes. Multi-component studies paired standing orders with interventions for providers frequently (34%-63% of studies), patients often (20%-49%), and systems least often (3%-14%). CONCLUSIONS: Standing orders show one of the largest effects among vaccine uptake interventions. Future research should focus on randomized trials, childhood vaccination, and behavioral aspects of implementation in healthcare systems.