HPV Vaccine Delivery Practices by Primary Care Physicians
HPV Vaccine Delivery Practices by Primary Care Physicians
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DOI：
10.1542/peds.2019-1475
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发表时间：
2019-10-01
期刊：
影响因子：
8
通讯作者：
Lindley, Megan C.
中科院分区：
文献类型：
--
作者：
Kempe, Allison;O'Leary, Sean T.;Lindley, Megan C.
背景和目的：在儿科医生和家庭医生（FP）中检查（1）人乳头瘤病毒（HPV）疫苗接种实践，（2）接种经验，（3）对新的2剂HPV疫苗接种计划的态度。方法：我们从2018年7月至2018年9月通过互联网或邮件调查了全国代表性的儿科医生和FP网络。多变量回归分析用于评估11- 12岁患者中拒绝或推迟率>= 50%的相关因素。结果：回复率为65%（包括302名儿科医生和228名FP）。强烈推荐HPV疫苗的儿科医生从≥ 15岁（女性）的99%到11至12岁（男性）的83%不等; FP从≥ 15岁（女性）的90%到11至12岁（男性）的66%不等（专业之间P < .0001）。65%的儿科医生和42%的FP在讨论HPV疫苗时总是或几乎总是使用假定风格（P < .0001）。总体而言，40%的人使用长期订单，42%的人使用电子警报。在儿科医生中，拒绝或推迟率>= 50%的比例在11至12岁的女性患者中为19%，男性患者中为23%; FP报告的比例分别为27%和36%。在多元回归中（男女），拒绝或推迟与医生不强烈推荐HPV疫苗给11至12岁的患者，不使用推定的方式，在将HPV疫苗引入13岁患者时，与11或12岁患者相比，在向11岁或12岁的患者推荐HPV疫苗时，预计会出现不舒服的谈话。89%的儿科医生和79%的FP报告说，更多的青少年结论：虽然大多数医生强烈建议11至12岁的患者接种HPV疫苗，但我们的数据显示，在推荐和接种方法方面需要改进。大多数医生认为，2剂的时间表是导致较高的HPV完成rates.In这篇文章中，我们报告目前的HPV交付实践的初级保健医生，展示领域的改进风格和强度的建议和实践为基础的交付方法。
BACKGROUND AND OBJECTIVES: To examine, among pediatricians and family physicians (FPs) (1) human papillomavirus (HPV) vaccine delivery practices, (2) delivery experiences, and (3) attitudes regarding new 2-dose HPV vaccination schedules. METHODS: We surveyed nationally representative networks of pediatricians and FPs by Internet or mail from July 2018 to September 2018. Multivariable regression was used to assess factors associated with refusal or deferral rates of >= 50% among 11- to 12-year-old patients. RESULTS: The response rate was 65% (302 pediatricians and 228 FPs included). Pediatricians who strongly recommended the HPV vaccine ranged from 99% for patients >= 15 years old (female) to 83% for those 11 to 12 years old (male); FPs ranged from 90% for patients >= 15 years old (female) to 66% for those 11 to 12 years old (male) (P < .0001 between specialties). Sixty-five percent of pediatricians and 42% of FPs always or almost always used presumptive style when discussing the HPV vaccine (P < .0001). Overall, 40% used standing orders and 42% had electronic alerts. Among pediatricians, the proportion reporting a refusal or deferral rate >= 50% was 19% for female patients and 23% for male patients 11 to 12 years old; FPs reported 27% and 36%, respectively. In the multivariable regression (both sexes), refusal or deferral was associated with physicians not strongly recommending the HPV vaccine to 11- to 12-year-old patients, not using a presumptive style, perceiving less resistance when introducing the HPV vaccine to a 13-year-old patient versus an 11- or 12-year-old patient, and anticipating an uncomfortable conversation when recommending the HPV vaccine to an 11- or 12-year-old patient. Eighty-nine percent of pediatricians and 79% of FPs reported that more adolescents CONCLUSIONS: Although most physicians strongly recommend the HPV vaccine to 11- to 12-year-old patients, our data reveal areas for improvement in recommendation and delivery methods. Most physicians perceive that the 2-dose schedule is resulting in higher HPV completion rates.In this article, we report current HPV delivery practices by primary care physicians, demonstrating areas for improvement in style and strength of recommendations and practice-based delivery methods.