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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:ObjectivesInterventions to improve health care provider communication about HPV vaccination can increase vaccine acceptance. Our objectives were to (1) identify clinics in locations with high HPV-associated cancer and low HPV-vaccination rates that would potentially benefit from dissemination of a proposed HPV Provider Communication intervention and (2) use qualitative interviews and a dissemination and implementation framework to assess readiness for change and fit of the HPV Provider Communication intervention to the context of these clinics.MethodsLocal HPV-associated cancer and HPV vaccination rates were assigned to Practice-Based Research Network clinics using data from the Colorado Central Cancer Registry, the Colorado Immunization Information System, and the American Community Survey. Staff from 38 clinics located in areas with high numbers of adolescents not up-to-date for HPV vaccine and high rates of HPV-associated cancers were recruited for qualitative interviews. Interview questions used the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework and addressed the proposed intervention, current vaccination practices and prior quality improvement (QI) experience.ResultsTwenty-seven interviews were completed with clinicians, clinic managers, and other staff across 17 clinics (9 pediatric, 5 family medicine, 3 public/school-based health). Most clinics had some prior QI experience and there were few thematic differences between sites with more or less foundation for QI/immunization work. Participants were motivated to improve the health of their patients and valued both guidelines and local experience as important evidence to consider adopting an intervention. Interviewees were more interested in implementing the proposed intervention if it aligned with existing priorities and fit within clinic workflows. Facilitation needs included adequate time and external facilitation support for data tracking and analysis.ConclusionsQualitative interviews to understand clinic context and fit of an HPV Provider Communication intervention can inform implementation in settings with the highest potential for clinical impact.

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.

Dataset Information

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

Publications

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

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