Simple and Elaborated Clinician Reminder Prompts for Human Papillomavirus Vaccination: A Randomized Clinical Trial
Simple and Elaborated Clinician Reminder Prompts for Human Papillomavirus Vaccination: A Randomized Clinical Trial
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DOI：
10.1016/j.acap.2017.11.002
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发表时间：
2018-03-01
影响因子：
3.1
通讯作者：
Downs, Stephen M.
中科院分区：
文献类型：
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作者：
Zimet, Gregory;Dixon, Brian E.;Downs, Stephen M.
目的：为了评估简单和详细的卫生保健提供者（HCP）提醒提示对人乳头瘤病毒（HPV）疫苗启动率的影响，方法：29名儿科HCP服务于5个儿科诊所被随机分为3组：1）常规实践控制，2）简单的提醒提示，3）详细的提醒提示，其中包括建议的语言推荐早期青少年平台疫苗。通过在5个诊所部署的基于计算机的临床决策支持系统提供咨询。符合条件的患者年龄为11至13岁，未接种HPV疫苗，应接种脑膜炎球菌ACWY（MenACWY）疫苗和/或破伤风，白喉和百日咳加强剂（Tdap）。HPV疫苗的接受通过发送到印第安纳州免疫登记处的自动查询来确定。数据进行分析，通过logistic回归模型，广义估计方程用于说明内HCPs.RESULTS集群的患者：10名HCP在对照组看到301例患者，8名HCP在简单的提示组看到124，11名HCP在详细提示组看到223。详细提示组的HPV疫苗接种率（62%）高于对照组（45%）：调整后的比值比为2.76; 95%置信区间为1.07至7.14。简单的提示手臂没有显着差异，从对照组就HPV疫苗启动，这可能是因为小样本量为这个arm. MenACWY和Tdap率并没有在3 arms.CONCLUSIONS：结果表明，详细的HCP有针对性的提醒提示，建议的建议语言，可能会提高HPV疫苗启动率。
OBJECTIVE: To evaluate the effects of simple and elaborated health care provider (HCP) reminder prompts on human papillomavirus (HPV) vaccine initiation rates.METHODS: Twenty-nine pediatric HCPs serving 5 pediatric clinics were randomized to 1 of 3 arms: 1) usual practice control, 2) simple reminder prompt, and 3) elaborated reminder prompt, which included suggested language for recommending the early adolescent platform vaccines. Prompts were delivered via a computer-based clinical decision support system deployed in the 5 clinics. Eligible patients were ages 11 to 13 years, had not received HPV vaccine, and were due for meningococcal ACWY (MenACWY) vaccine and/or the tetanus, diphtheria, and pertussis booster (Tdap). Receipt of HPV vaccine was determined via automated queries sent to the Indiana immunization registry. Data were analyzed via logistic regression models, with generalized estimating equations used to account for the clustering of patients within HCPs.RESULTS: Ten HCPs in the control group saw 301 patients, 8 HCPs in the simple prompt group saw 124, and 11 HCPs in the elaborated prompt group saw 223. The elaborated prompt arm had a higher rate of HPV vaccination (62%) than the control arm (45%): adjusted odds ratio, 2.76; 95% confidence interval, 1.07 to 7.14. The simple prompt arm did not differ significantly from the control arm with respect to HPV vaccine initiation, which might have been because of the small sample size for this arm. MenACWY and Tdap rates did not vary across the 3 arms.CONCLUSIONS: Results suggest that an elaborated HCP-targeted reminder prompt, with suggested recommendation language, might improve rates of HPV vaccine initiation.