What Impacts HPV Vaccination Recommendations? An Exploration of Medical Residents' Knowledge, Training, Barriers, and Practices
What Impacts HPV Vaccination Recommendations? An Exploration of Medical Residents' Knowledge, Training, Barriers, and Practices
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DOI：
10.22454/fammed.2020.132480
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发表时间：
2020-11-01
期刊：
影响因子：
1.9
通讯作者：
Spielberg, Freya
中科院分区：
文献类型：
--
作者：
Hansen, Katie;Ward, Megan;Spielberg, Freya
背景和目的：增加人乳头瘤病毒疫苗（HPVV）的接种对于预防宫颈癌至关重要。有效的医生沟通和临床工作流程政策对疫苗接种率有重大影响。然而，住院医师培训计划在是否包含有效 HPVV 实践培训方面有所不同。在德克萨斯州奥斯汀的戴尔医学院，初级保健住院医师诊所的 HPVV 感染率各不相同。我们检查了儿科 (Peds)、家庭医学 (FM)、妇产科 (Ob/Gyn) 和内科 (IM) 住院医师的 HPVV 相关知识、培训、障碍和实践，旨在确定提高疫苗接种率的干预目标。 方法：这是一项混合方法研究，包括定性访谈和调查。我们采访了来自各个专业的住院医师样本，以评估他们的培训经历以及他们如何讨论 HPVV。我们对访谈进行录音、转录和编码，以进行主题分析。所有居民都有机会完成电子调查，以定量评估知识和疫苗实践。我们进行了 chi(2) 和 Fisher 精确分析来比较学科之间的结果。结果：HPVV 相关知识在所有四个专业和住院医师年份之间是相似的。 Peds 居民报告称，对于 11-17 岁女性，他们总是比 FM 和妇产科居民更推荐 HPVV。只有 Peds 居民报告接受了循证疫苗沟通培训。在所有居民中，HPVV 的主要障碍包括忘记提供疫苗和时间限制。在讨论疫苗时，许多接受采访的居民并没有向所有符合条件的患者提供自信的建议，而是使用基于风险的疫苗接种方法。结论：与居民接受 HPVV 培训的方式和地点相关的项目之间存在不一致。这可能会影响居民疫苗建议的频率和强度。为了提高 HPVV 感染率，住院医师计划应优先考虑实施多模式干预措施，包括选择退出工作流程以及如何提供自信的疫苗建议的教育。
BACKGROUND AND OBJECTIVES: Increasing human papillomavirus vaccination (HPVV) uptake is critical to the prevention of cervical cancer. Effective physician communication and clinical workflow policies have a significant impact on vaccination rates. However, resident training programs vary in the inclusion of training in effective HPVV practices. At Dell Medical School in Austin, Texas, HPVV rates at primary care residents' clinic sites vary. We examined HPVV-related knowledge, training, barriers, and practices among residents in pediatrics (Peds), family medicine (FM), obstetrics and gynecology (Ob/Gyn), and internal medicine (IM) with the aim of identifying interventional targets to improve vaccination rates.METHODS: This was a mixed-method study including qualitative interviews and a survey. We interviewed a sample of residents from each specialty to assess their training experiences and how they discuss HPVV. We recorded, transcribed, and coded interviews for thematic analysis. All residents were offered the opportunity to complete an electronic survey to quantitatively evaluate knowledge and vaccine practices. We performed chi(2) and Fisher exact analysis to compare results between disciplines.RESULTS: HPVV-related knowledge was similar across all four specialties and between resident year. Peds residents reported always recommending the HPVV significantly more than FM and Ob/Gyn residents for 11-17-year-old females. Only Peds residents reported receiving evidence-based vaccine communication training. Among all residents, the primary HPVV barriers included forgetting to offer the vaccine and time constraints. When discussing the vaccine, many interviewed residents were not offering a confident recommendation to all eligible patients, and instead were using a risk-based approach to vaccination.CONCLUSIONS: There were inconsistencies across programs related to how and where residents receive HPVV training. This may impact the frequency and strength of resident vaccine recommendations. To increase HPVV rates, residency programs should prioritize implementation of multimodal interventions, including opt-out workflows and education on how to give confident vaccine recommendations.