Provider and Practice Experience Integrating the Dose-HPV Intervention into Clinical Practice.
Provider and Practice Experience Integrating the Dose-HPV Intervention into Clinical Practice.
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DOI：
10.1097/ceh.0000000000000363
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发表时间：
2021-07-01
期刊：
影响因子：
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通讯作者：
Perkins RB
中科院分区：
文献类型：
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作者：
Drainoni ML;Biancarelli D;Jansen E;Bernstein J;Joseph N;Eun TJ;Fenton AHTR;Clark JA;Hanchate A;Legler A;Schuch TJ;Leschly K;Perkins RB
很少有研究严格评估成功实施干预措施以提高人乳头瘤病毒（HPV）疫苗接种率的驱动因素。本研究的目的是评估HPV疫苗接种系统和教育发展（DOSE HPV）的实施情况，这是一种绩效改善干预措施。初级保健提供者（PCP），护士，以及参加DOSE HPV干预会议的儿科和家庭医学实践的领导角色的个人在干预完成后立即参加了定性访谈。研究小组专业地转录访谈，并使用归纳法进行定性编码。最后的分析采用了促进卫生服务研究实施行动（PARiHS）模式。26个人参加：12个PCP，5名护士，和9个人的双重领导和PCP的角色。参与者描述了他们认为有助于项目成功的五个因素：（1）以证据为基础，目标导向的教育;（2）个性化的数据反馈;（3）临床领导支持;（4）协作促进;（5）重复接触/干预的纵向结构。实施干预措施的障碍包括：（1）无法标准化实践中的工作流程;（2）儿科量低;（3）竞争优先级/缺乏激励措施;（4）护士的有效参与;（5）临床领导和工作人员之间的沟通不良。虽然已经实施了许多HPV检测干预措施，但结果喜忧参半。很明显，仅仅有一个有效的、基于证据的干预措施本身并不足以将其付诸实践。相反，至关重要的是要考虑执行因素，以确保一致的执行和可持续性。DOSE HPV干预成功的关键因素似乎包括合作方法，提供有用的证据来激励行为改变，以及反复联系以确保实施改变的责任。工作流程问题、无效的沟通渠道以及访视和患者及人口管理层面的竞争优先事项可能会阻碍实施。
Few studies have rigorously evaluated the drivers of successful implementation of interventions to improve human papillomavirus (HPV) vaccination rates. The aim of this study was to evaluate the implementation of Development of Systems and Education for HPV Vaccination (DOSE HPV), a performance improvement intervention. Primary care providers (PCPs), nurses, and individuals with leadership roles from pediatric and family medicine practices who attended DOSE HPV intervention sessions participated in qualitative interviews immediately following intervention completion. The study team professionally transcribed interviews and performed qualitative coding using inductive methods. Final analysis employed the Promoting Action on Research implementation in Health Services (PARiHS) model. Twenty-six individuals participated: 12 PCPs, 5 nurses, and 9 individuals with dual leadership and PCP roles. Participants described five factors that they felt contributed to program success: (1) evidence-based, goal-directed education; (2) personalized data feedback; (3) clinical leadership support; (4) collaborative facilitation; (5) repeated contacts/longitudinal structure of the intervention. Barriers to implementing the intervention included: (1) inability to standardize workflow across practices; (2) low pediatric volume, (3) competing priorities/lack of incentives, (4) ineffective involvement of nurses, (5) poor communication between clinical leadership and staff. Although many HPV testing interventions have been implemented, findings have been mixed. It is clear that having an effective, evidence-based intervention by itself is not enough to get it into practice. Rather, it is crucial to consider implementation factors to ensure consistent implementation and sustainability. Key factors for the success of the DOSE HPV intervention appear to include a collaborative approach, provision of useful evidence to motivate behavior change, and repeated contacts to ensure accountability for implementing changes. Workflow issues, ineffective lines of communication, and competing priorities at both the visit and the patient and population management levels can hinder implementation.