Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus Vaccination Rates A Cluster Randomized Clinical Trial
Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus Vaccination Rates A Cluster Randomized Clinical Trial
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DOI：
10.1001/jamapediatrics.2021.0766
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发表时间：
2021-05-24
期刊：
影响因子：
26.1
通讯作者：
Fiks, Alexander G.
中科院分区：
文献类型：
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作者：
Szilagyi, Peter G.;Humiston, Sharon G.;Fiks, Alexander G.
在儿童卫生保健访问期间错过人乳头瘤病毒（HPV）疫苗接种的机会是常见的。目的评估临床医生在线交流培训对总体HPV疫苗接种率、儿童保健（WCC）就诊、急性或慢性疾病就诊（以下简称急性或慢性就诊）和青少年HPV疫苗接种率错失机会的影响。设计、环境和参与者2018年12月26日至2019年7月30日，一项纵向聚类随机临床试验在交错的6个月期间将实践分配给沟通培训和标准护理。从美国儿科学会办公室环境儿科研究网络中招募了19个州的48家初级保健儿科诊所。参与者是参与干预实践的临床医生。对所有参加24个干预实践（188名临床医生）和24个对照实践（177名临床医生）的11至17岁青少年的结果进行了评估。分析是随机的，并在意向治疗的基础上进行，考虑到实践中的聚类。干预措施开发了三个连续的在线教育模块，以帮助参与的临床医生与家长就HPV疫苗进行沟通。每周向参与的临床医生发送短信，以加强学习。统计学家对分组分配是盲目的。主要结局和措施主要结局是错过了HPV疫苗接种的总体机会，HPV疫苗接种的开始和随后的WCC剂量以及急性或慢性就诊（就诊水平结局）。次要结局是HPV疫苗接种率（个人水平结局）。将干预期间的结果与基线进行比较。结果188名临床医生中有122名参与了干预实践；其中，分别有120、119和116名临床医生完成了培训模块1、2和3。在干预期间，29 206名青少年（14 664名女孩[50.2%]，平均[SD]年龄14.2[2.0]岁）进行了15 888次WCC和28 123次急性或慢性就诊；33 914名青少年（17 069名女孩[50.3%]；平均[SD]年龄14.2[2.0]岁）就诊17 910次WCC和35 281次急慢性就诊。总体而言，干预措施比对照组减少了2.4个百分点（-2.4%;95% CI, -3.5%至-1.2%）的错失机会。干预措施减少了WCC就诊期间接种疫苗的机会，比对照组减少了6.8个百分点（-6.8%;95% CI, -9.7%至-3.9%）。干预对错过后续HPV疫苗剂量或急性或慢性就诊的机会没有影响。与对照组相比，接受干预的青少年在HPV疫苗接种方面有3.4个百分点（95% CI, 0.6%-6.2%）的改善。结论和相关性这种可扩展的在线交流培训增加了HPV疫苗接种，特别是在WCC就诊时开始接种HPV疫苗。结果支持该干预措施的推广。
IMPORTANCE Missed opportunities for human papillomavirus (HPV) vaccination during pediatric health care visits are common.OBJECTIVES To evaluate the effect of online communication training for clinicians on missed opportunities for HPV vaccination rates overall and at well-child care (WCC) visits and visits for acute or chronic illness (hereafter referred to as acute or chronic visits) and on adolescent HPV vaccination rates.DESIGN, SETTING, AND PARTICIPANTS From December 26, 2018, to July 30, 2019, a longitudinal cluster randomized clinical trial allocated practices to communication training vs standard of care in staggered 6-month periods. A total of 48 primary care pediatric practices in 19 states were recruited from the American Academy of Pediatrics Pediatric Research in Office Settings network. Participants were clinicians in intervention practices. Outcomes were evaluated for all 11- to 17-year-old adolescents attending 24 intervention practices (188 clinicians) and 24 control practices (177 clinicians). Analyses were as randomized and performed on an intent-to-treat basis, accounting for clustering by practice.INTERVENTIONS Three sequential online educational modules were developed to help participating clinicians communicate with parents about the HPV vaccine. Weekly text messages were sent to participating clinicians to reinforce learning. Statisticians were blinded to group assignment.MAIN OUTCOMES AND MEASURES Main outcomes were missed opportunities for HPV vaccination overall and for HPV vaccine initiation and subsequent doses at WCC and acute or chronic visits (visit-level outcome). Secondary outcomes were HPV vaccination rates (person-level outcome). Outcomes were compared during the intervention vs baseline.RESULTS Altogether, 122 of 188 clinicians in intervention practices participated; of these, 120, 119, and 116 clinicians completed training modules 1, 2, and 3, respectively. During the intervention period, 29 206 adolescents (14 664 girls [50.2%]; mean [SD] age, 14.2 [2.0] years) made 15 888 WCC and 28 123 acute or chronic visits to intervention practices; 33 914 adolescents (17 069 girls [50.3%]; mean [SD] age, 14.2 [2.0] years) made 17 910 WCC and 35 281 acute or chronic visits to control practices. Intervention practices reduced missed opportunities overall by 2.4 percentage points (-2.4%; 95% CI, -3.5% to -1.2%) more than controls. Intervention practices reduced missed opportunities for vaccine initiation during WCC visits by 6.8 percentage points (-6.8%; 95% CI, -9.7% to -3.9%) more than controls. The intervention had no effect on missed opportunities for subsequent doses of the HPV vaccine or at acute or chronic visits. Adolescents in intervention practices had a 3.4-percentage point (95% CI, 0.6%-6.2%) greater improvement in HPV vaccine initiation compared with adolescents in control practices.CONCLUSIONS AND RELEVANCE This scalable, online communication training increased HPV vaccination, particularly HPV vaccine initiation at WCC visits. Results support dissemination of this intervention.