Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial
Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial
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DOI：
10.1542/peds.2016-1764
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发表时间：
2017-01-01
期刊：
影响因子：
8
通讯作者：
Lathren, Christine
中科院分区：
文献类型：
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作者：
Brewer, Noel T.;Hall, Megan E.;Lathren, Christine
目标：改善提供者的建议对于解决人乳头瘤病毒 (HPV) 疫苗接种覆盖率低的问题至关重要。因此，我们试图确定培训提供者使用推定性“公告”或参与性“对话”来改进其建议的有效性。方法：2015 年，我们在北卡罗来纳州中部的 30 个儿科和家庭医学诊所进行了一项平行组随机临床试验。我们随机分配诊所不接受任何培训（对照）、公告培训或对话培训。公告是假设父母已准备好接种疫苗的简短声明，而对话则是让父母进行开放式讨论。一名医生主持了 1 小时的临床培训。北卡罗来纳州免疫登记处提供了主要试验结果的数据：11 或 12 岁青少年 HPV 疫苗接种（>= 1 剂）的 6 个月覆盖率变化。结果：免疫登记处将 17 173 名 11 或 12 岁青少年归入培训后 6 个月仍开放的 29 家诊所。与对照诊所的患者相比，接受公告培训的诊所的患者 HPV 疫苗接种覆盖率在六个月内的增幅更大（差异 5.4%，95% 置信区间：1.1%-9.7%）。分层分析显示女孩（差异 4.6%）和男孩（差异 6.2%）均有所增加。接受对话培训的诊所的患者与对照诊所的患者在 HPV 疫苗接种覆盖率的变化方面没有差异。这两种培训对于改变其他疫苗接种结果或 13 至 17 岁青少年 (n = 37 796) 的覆盖范围都无效。结论：使用公告的培训提供者导致年轻青少年中 HPV 疫苗接种的临床有意义的增加。
OBJECTIVE: Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive "announcements" or participatory "conversations."METHODS: In 2015, we conducted a parallel-group randomized clinical trial with 30 pediatric and family medicine clinics in central North Carolina. We randomized clinics to receive no training (control), announcement training, or conversation training. Announcements are brief statements that assume parents are ready to vaccinate, whereas conversations engage parents in open-ended discussions. A physician led the 1-hour, in-clinic training. The North Carolina Immunization Registry provided data on the primary trial outcome: 6-month coverage change in HPV vaccine initiation (>= 1 dose) for adolescents aged 11 or 12 years.RESULTS: The immunization registry attributed 17 173 adolescents aged 11 or 12 to the 29 clinics still open at 6-months posttraining. Six-month increases in HPV vaccination coverage were larger for patients in clinics that received announcement training versus those in control clinics (5.4% difference, 95% confidence interval: 1.1%-9.7%). Stratified analyses showed increases for both girls (4.6% difference) and boys (6.2% difference). Patients in clinics receiving conversation training did not differ from those in control clinics with respect to changes in HPV vaccination coverage. Neither training was effective for changing coverage for other vaccination outcomes or for adolescents aged 13 through 17 (n = 37 796).CONCLUSIONS: Training providers to use announcements resulted in a clinically meaningful increase in HPV vaccine initiation among young adolescents.