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Immunization effects of a communication intervention to promote preteen HPV vaccination in primary care practices.

ABSTRACT: OBJECTIVES:HPV vaccination at the recommended ages of 11-12 is highly effective yet has stalled well below the goal of 80% of the population. We evaluated a statewide practice-based communication intervention (tools: brochures, posters, online training for providers and resources for parents, video game for preteens) to persuade parents, preteens and providers to vaccinate against HPV. The 9-month intervention started May 1, 2015. METHODS:We compared vaccine initiation and completion rates over three 9-month periods (baseline, intervention, post-intervention) between practices enrolled in the intervention and a comparable comparison group. All practices reported to the North Carolina Immunization Registry (NCIR) and had at least 100 11- and 12-year-olds who had not completed the HPV vaccine series. Of 175 eligible practices, the 14 intervention practices included 19,398 individuals and the 161 comparison practices included 127,896 individuals. An extended Cox model was used to test the intervention effect. RESULTS:The intervention had a significant effect on both initiation and completion during the intervention and post-intervention periods; the estimated hazard ratio (HR) for initiation was 1.17 (p?=?.004) during the intervention and 1.11 (p?=?.005) post-intervention. Likewise, completion during the intervention period was 17% higher in intervention practices, after controlling for baseline differences. This effect increased in the post-intervention period to 30% higher (p?=?.03). CONCLUSIONS:Individuals in the intervention practices were 17% more likely to initiate and complete HPV vaccination than in the comparison practices during the intervention period and the effect was sustained post-intervention. This intervention is promising for increasing rates of HPV vaccination at ages 11-12.

SUBMITTER: Cates JR

PROVIDER: S-EPMC5725272 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Immunization effects of a communication intervention to promote preteen HPV vaccination in primary care practices.

Cates Joan R JR Crandell Jamie L JL Diehl Sandra J SJ Coyne-Beasley Tamera T

Vaccine 20171121 1

<h4>Objectives</h4>HPV vaccination at the recommended ages of 11-12 is highly effective yet has stalled well below the goal of 80% of the population. We evaluated a statewide practice-based communication intervention (tools: brochures, posters, online training for providers and resources for parents, video game for preteens) to persuade parents, preteens and providers to vaccinate against HPV. The 9-month intervention started May 1, 2015.<h4>Methods</h4>We compared vaccine initiation and complet ...[more]

PMID: 29169892

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Project description:BACKGROUND:Adult immunization rates are below Healthy People 2020 targets. Our objective was to evaluate the effectiveness of a multicomponent intervention to improve adult immunization rates. METHODS:This prospective interventional before-and-after non-randomized study was conducted through the American Academy of Family Physicians National Research Network with 43 primary care physicians from a large multi-specialty healthcare organization (multicomponent intervention group n?=?23; comparator group n?=?20) in the United States. The multicomponent intervention included provider reminders, quarterly provider-level performance reports, provider education, patient visual aid materials, and standing orders on adult pneumococcal, influenza, and zoster immunizations. We assessed individual and comparative provider-level vaccination rates and missed opportunities detailing concordance with targets established by Healthy People 2020 for pneumococcal, influenza, and zoster immunizations. RESULTS:Vaccination rates increased after 12?months in intervention and comparator groups respectively for: a). influenza from 44.4?±?16.7 to 51.3%?±?12.9% (by 6.9 percentage points, p?=?0.001) and from 35.1?±?19.1 to 41.3%?±?14.2%, (by 6.2 percentage points, p?=?0.01); b). pneumococcal vaccinations in older adults from 62.8?±?17.6 to 81.4%?±?16.6% (by 18.6 percentage points, for p?<?0.0001) and from 55.9?±?20.0 to 72.7%?±?18.4% (by 16.7 percentage points, p?<?0.0001); and c). zoster from 37.1?±?13.4 to 41.9%?±?13.1% (by 4.8 percentage points, p?<?0.0001) and from 35.0?±?18.7 to 42.3%?±?20.9% (7.3 percentage points, p?=?0.001). Pneumococcal vaccinations in adults at risk did not change from baseline in intervention group (35.7?±?19.6 to 34.5%?±?19.0%, p?=?0.3) and improved slightly in comparator group (24.3?±?20.1 to 28.2%?±?20.0%, p?=?0.003). Missed opportunities reduced after 12?months, most noticeably, for: a). for influenza from 57.7 to 48.6% (by 9.1 percentage points, p?<?0.0001) and from 69.7 to 59.6% (by 10.1 percentage points, p?<?0.0001); b). pneumococcal vaccinations in older adults from 18.1 to 11.5% (by 6.6 percentage points p?<?0.0001) and from 24.6 to 20.4% (by 4.3 percentage points, p?<?0.0001) in intervention and comparator groups respectively. CONCLUSIONS:Multicomponent interventions show promise in improving vaccination rates and reducing missed opportunities in older adults for pneumococcal and zoster vaccines and vaccination against influenza. Provider reminders remain the most effective strategy when delivered either as a component of these interventions or alone.

Project description:BackgroundIncreasing antimicrobial resistance is a serious societal challenge affecting outpatient, inpatient and veterinary care. The German One-Health project, RAI (Rational use of Antibiotics via Information and Communication) addresses all three sectors. In the outpatient sector, General Practitioners (GPs) are the main prescribers of antibiotics and were therefore, targeted for this study. A multimodal intervention focusing on Acute Respiratory Tract infections (ARI) was designed and implemented. The aim of this study was to evaluate acceptance, rating and the self-reported impact of the intervention among GPs.MethodsThe intervention offered six tools: a GP training on rational antibiotic use, an app for self-monitoring, a leaflet and a set of posters (both for use as information materials in waiting rooms) and both digital and printed information prescriptions (material for 'prescribing' information instead of an antibiotic to the patient). The tools could be used according to individual preferences. The intervention was conducted between August 2016 and July 2017. Following the intervention, a three pages anonymous questionnaire was sent to all 271 participants. Items covered socio-demographic and professional background, use and judgement of the intervention tools (6 point Likert scale), impact of the intervention tools (4 point Likert scale).ResultsThe response rate was 39% (n = 107). On average, respondents used 3.1 of the six available tools, with printed information prescriptions used most frequently (79%). Digital information prescriptions were used more frequently by men than by women (OR 2.8; 95% CI 1.16-7.24; p = 0.02). Eighty-seven percent of respondents stated that information prescriptions supported doctor-patient communication. In a comparison of the overall impression of the different intervention tools the GP training on rational antibiotic use was rated best (1.67 on a 6 point scale with 1 = highest, 6 = lowest) and most often noted as having had a "strong" or "very strong" impact on personal antibiotic prescribing behavior.ConclusionsThe multimodal intervention addressing education and communication was well accepted among GPs and could help in fostering rational use of antibiotics in primary care.

Project description:BackgroundClinical guidelines exhort clinicians to encourage patients to improve their health behaviours. However, most offer little support on how to have these conversations in practice. Clinicians fear that health behaviour change talk will create interactional difficulties and discomfort for both clinician and patient. This review aims to identify how healthcare professionals can best communicate with patients about health behaviour change (HBC).MethodsWe included studies which used conversation analysis or discourse analysis to study recorded interactions between healthcare professionals and patients. We followed an aggregative thematic synthesis approach. This involved line-by-line coding of the results and discussion sections of included studies, and the inductive development and hierarchical grouping of descriptive themes. Top-level themes were organised to reflect their conversational positioning.ResultsOf the 17,562 studies identified through systematic searching, ten papers were included. Analysis resulted in 10 top-level descriptive themes grouped into three domains: initiating; carrying out; and closing health behaviour change talk. Of three methods of initiation, two facilitated further discussion, and one was associated with outright resistance. Of two methods of conducting behaviour change talk, one was associated with only minimal patient responses. One way of closing was identified, and patients did not seem to respond to this positively. Results demonstrated a series of specific conversational practices which clinicians use when talking about HBC, and how patients respond to these. Our results largely complemented clinical guidelines, providing further detail on how they can best be delivered in practice. However, one recommended practice - linking a patient's health concerns and their health behaviours - was shown to receive variable responses and to often generate resistance displays.ConclusionsHealth behaviour change talk is smoothly initiated, conducted, and terminated by clinicians and this rarely causes interactional difficulty. However, initiating conversations by linking a person's current health concern with their health behaviour can lead to resistance to advice, while other strategies such as capitalising on patient initiated discussions, or collaborating through question-answer sequences, may be well received.

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Immunization effects of a communication intervention to promote preteen HPV vaccination in primary care practices.

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Immunization effects of a communication intervention to promote preteen HPV vaccination in primary care practices.

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