Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination A Cluster Randomized Clinical Trial
Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination A Cluster Randomized Clinical Trial
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DOI：
10.1001/jamapediatrics.2018.0016
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发表时间：
2018-05-01
期刊：
影响因子：
26.1
通讯作者：
O'Leary, Sean T.
中科院分区：
文献类型：
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作者：
Dempsey, Amanda F.;Pyrznawoski, Jennifer;O'Leary, Sean T.
重要性美国每年与人类乳头瘤病毒(HPV)相关的癌症的发病率超过35000例。有效的HPV疫苗在美国已经有好几年了，但在青少年中使用不足，青少年是接种疫苗的目标人群。目的评价5成分卫生保健专业HPV疫苗沟通干预对青少年HPV疫苗接种的影响。设计、设置和参与者在科罗拉多州丹佛市的16个初级保健机构中进行了一项整群随机临床试验，使用协变量受限随机分配研究武器和意向治疗方案。参与者包括188名医疗专业人员和43 132名青少年。干预的5个组成部分是：创建与每个实践的患者群体相关的定制信息表的HPV情况说明库，定制的家长教育网站，一套HPV相关疾病图像，HPV疫苗决策辅助工具，以及关于使用推定疫苗推荐的2.5小时沟通培训，然后是对父母是否对疫苗接种有抵抗力的激励性访谈。每个实践在干预前的6个月内(2014年8月1日至2015年1月31日)参加了一系列2次干预开发会议。在2015年2月1日至2016年1月31日期间，在实践中看到的11至17岁患者的HPV疫苗系列启动(=1剂)和完成(&>=3剂)中，主要结果和衡量控制和干预随时间变化的差异(即，患者的基线和干预期队列之间的差异)。结果16个实施点和43132例患者(女性占50.3%，研究开始时中位年龄为12.6岁[四分位数范围10.8~14.7岁])参与了本次试验。干预措施中的青少年HPV疫苗系列启动(调整优势比[AOR]，1.46；95%CI，1.31~1.62)和完成(AOR，1.56；95%CI，1.27~1.92)的概率显著高于对照干预措施中的青少年(HPV疫苗系列启动增加9.5个绝对百分点，HPV疫苗系列完成增加4.4个百分点)。干预在儿科实践中比家庭医学实践中有更大的效果，在私人实践中比公共实践中有更大的效果。卫生保健专业人员报告说，沟通培训和情况说明书是最常用和有用的干预成分。结论与相关性A卫生保健专业人员沟通干预显著提高了青少年患者HPV疫苗系列的启动和完成。
IMPORTANCE The incidence of human papillomavirus (HPV)-related cancers is more than 35 000 cases in the United States each year. Effective HPV vaccines have been available in the United States for several years but are underused among adolescents, the target population for vaccination. Interventions to increase uptake are needed.OBJECTIVE To evaluate the effect of a 5-component health care professional HPV vaccine communication intervention on adolescent HPV vaccination.DESIGN, SETTING, AND PARTICIPANTS A cluster randomized clinical trial using covariate-constrained randomization to assign study arms and an intent-to-treat protocol was conducted in 16 primary care practices in the Denver, Colorado, metropolitan area. Participants included 188 medical professionals and 43 132 adolescents.INTERVENTIONS The 5 components of the intervention were an HPV fact sheet library to create customized information sheets relevant to each practice's patient population, a tailored parent education website, a set of HPV-related disease images, an HPV vaccine decision aid, and 2 1/2 hours of communication training on using a presumptive vaccine recommendation, followed by motivational interviewing if parents were resistant to vaccination. Each practice participated in a series of 2 intervention development meetings over a 6-month period (August 1, 2014, to January 31, 2015) before the intervention.MAIN OUTCOMES AND MEASURES Differences between control and intervention changes over time (ie, difference in differences between the baseline and intervention period cohorts of patients) in HPV vaccine series initiation (>= 1 dose) and completion (>= 3 doses) among patients aged 11 to 17 years seen at the practices between February 1, 2015, and January 31, 2016. Vaccination data were obtained from the practices' records and augmented with state immunization information system data.RESULTS Sixteen practices and 43 132 patients (50.3% female; median age, 12.6 years [interquartile range, 10.8-14.7 years] at the beginning of the study period) participated in this trial. Adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.62) and completion (aOR, 1.56; 95% CI, 1.27-1.92) than those in the control practices (a 9.5-absolute percentage point increase in HPV vaccine series initiation and a 4.4-absolute percentage point increase in HPV vaccine series completion in intervention practices). The intervention had a greater effect in pediatric practices compared with family medicine practices and in private practices compared with public ones. Health care professionals reported that communication training and the fact sheets were the most used and useful intervention components.CONCLUSIONS AND RELEVANCE A health care professional communication intervention significantly improved HPV vaccine series initiation and completion among adolescent patients.