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Vaccination Programs: Standing Orders


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2009 pdf icon [PDF - 171 kB] (29 studies, search period 1997-2009) combined with more recent evidence (6 studies, search period 2009-February 2012).

This review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to increasing appropriate vaccination.


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Summary of Results

More details about study results are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 514 kB].

The systematic review included 35 studies.

  • Overall, vaccination rates increased by a median of 24 percentage points (27 studies).
    • Standing orders used alone increased vaccination rates by a median of 16 percentage points (9 studies).
    • Standing orders used in combination with additional interventions increased vaccination rates by a median of 27 percentage points (19 studies).
  • Standing orders increased vaccination rates among children by a median of 28 percentage points (4 studies).
  • All of the studies that did not provide a common measure of change for vaccination rates reported favorable results (7 studies).

Summary of Economic Evidence

More details about study results are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 514 kB].

Three U.S. studies that evaluated the economics of standing orders for pneumococcal, influenza, and Tdap vaccines were included in the economic review (search period 1980–2012). All monetary values are reported in 2013 U.S. dollars.

  • The median intervention cost was $5.55 per person per year (3 studies).
  • The median cost was $29 per additional vaccinated person (3 studies).
  • Intervention groups had a median size of 11,813 clients (3 studies).


CPSTF findings should be applicable to the following:

  • Various clinical settings (e.g., clinics, hospitals, long-term care facilities)
  • Different vaccination providers (e.g., nurses, pharmacists)
  • Children, adolescents, and adults
  • Inpatient and outpatient settings

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • How effective are these interventions for adolescent populations?
  • How effective are these policies in communities with disparities in vaccination rates?
  • What are strategies to address implementation barriers for standing orders in systems of care?

Study Characteristics

  • Included studies were conducted in a wide range of clinical settings, including healthcare clinics, hospitals, and long-term care facilities.
  • Evaluated interventions were used with different vaccination providers including nurses and pharmacists.