Implementing Evidence-Based Strategies to Improve HPV Vaccine Delivery
Implementing Evidence-Based Strategies to Improve HPV Vaccine Delivery
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DOI：
10.1542/peds.2018-2500
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发表时间：
2019-07-01
期刊：
影响因子：
8
通讯作者：
Terk, Jason, V
中科院分区：
文献类型：
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作者：
Gilkey, Melissa B.;Parks, Michael J.;Terk, Jason, V
背景：高质量的证据表明，与卫生保健提供者的干预改善了人乳头瘤病毒（HPV）疫苗的接种。然而，在现实世界的临床实践中扩大循证策略仍然具有挑战性。我们试图通过在大型非营利医疗保健系统中进行本地调整和实施，提高HPV疫苗接种质量改进（QI）策略的覆盖范围和影响。方法：我们利用现有材料进行了HPV疫苗接种QI计划，以支持医生培训以及评估和反馈。HPV疫苗接种率高的当地医生促进了培训，其中包括教学指导和视频短片，以模拟有效的沟通。我们将25家诊所的77名医生随机分配到QI组或等待名单对照组。我们使用分层线性模型评估12至14岁患者6个月内的HPV疫苗接种覆盖率（>= 1剂）。结果：在QI组的45名医生中，通过培训加评估和反馈，该计划达到43名（95%）。在总体样本中，QI和对照组的HPV疫苗接种率均有所增加（分别为8.6和6.4个百分点），尽管2.2个百分点的差异没有达到统计学显著性。排除数据质量差的医生的敏感性分析表明，QI与对照组相比有3.3个百分点的统计学显著优势（B = 0.034; SE = 0.015; P <0.05）。结论：我们的本地适应性QI计划取得了很好的覆盖率，HPV疫苗接种覆盖率略有提高。未来的实施研究需要加强计划的影响，并支持卫生系统利用当地资源有效地开展这些计划。
BACKGROUND:High-quality evidence indicates that intervening with health care providers improves human papillomavirus (HPV) vaccine delivery. However, scaling up evidence-based strategies in real-world clinical practice remains challenging. We sought to improve the reach and impact of strategies for HPV vaccination quality improvement (QI) through local adaptation and implementation in a large, not-for-profit health care system.METHODS:We conducted an HPV vaccination QI program using existing materials to support physician training coupled with assessment and feedback. Local physicians with high HPV vaccination rates facilitated training, which included didactic instruction and video vignettes modeling effective communication. We randomly assigned 25 clinics with 77 physicians to the QI arm or the wait-list control arm. We used hierarchical linear models to assess HPV vaccination coverage (>= 1 dose) over 6 months among patients aged 12 to 14.RESULTS:Of 45 physicians in the QI arm, the program reached 43 (95%) with training plus assessment and feedback. In the overall sample, HPV vaccination coverage increased in both the QI and control arms (8.6 vs 6.4 percentage points, respectively), although the 2.2-percentage point difference did not reach statistical significance. Sensitivity analyses that excluded physicians with poor data quality indicated a statistically significant advantage of 3.3 percentage points for QI versus control (b = 0.034; SE = 0.015; P < .05).CONCLUSIONS:Our locally adapted QI program achieved excellent reach, with small improvements in HPV vaccination coverage. Future implementation research is needed to bolster program impact and support health systems in leveraging local resources to conduct these programs efficiently.