Delivery of Adolescent Preventive Services in the Era of New Adolescent Vaccines

描述（由申请人提供）：近年来，随着预防脑膜炎球菌病的结合疫苗、预防人乳头瘤病毒的另一种疫苗和新的破伤风类毒素-白喉-百日咳疫苗的许可，青少年的免疫接种变得更加复杂。在不久的将来，可能会提出影响青少年的其他疫苗建议，包括普遍接种流感疫苗的建议，以及未来开发和许可预防巨细胞病毒、单纯疱疹病毒和潜在的沙眼衣原体的疫苗。部分由于疫苗接种的成功，青春期发病和死亡的主要原因与可预防的健康行为有关，包括烟草、酒精和药物使用、危险性活动、精神健康和伤害。青少年预防服务指南已由多个专业组织制定和认可，包括美国医学协会（AMA）、美国儿科学会（AAP）、美国家庭医生学会（AAFP）和美国妇幼卫生局（MCHB），以指导医生为这些健康问题提供预防性咨询和筛查。然而，目前尚不清楚医生如何将青少年疫苗的提供与临床预防服务（CPS）的提供结合起来，以及疫苗的提供是加强还是阻碍了其他预防服务的提供。该项目将通过关键信息提供者访谈和焦点小组，评估家庭医生和儿科医生对提供青少年预防服务的知识、态度和做法。我们还将定性地评估各种环境（城市、郊区、农村、服务不足）和实践类型（健康维护组织、私人、诊所/社区健康中心）的医生如何优先为青少年提供CPS，我们将评估改善CPS交付的潜在方法。为了量化CPS和免疫接种的提供，我们将对400名青少年进行图表审查，并在纽约州北部的实践中采访这些青少年（11-14岁和15-18岁）及其父母（200名11-14岁儿童的父母）。这些访谈也将提高我们对家长和青少年对CPS的态度的理解。该项目的结果将指导今后的教育和基于实践的战略，以提高青少年CPS和免疫接种率。我们的项目将探讨医生如何在为青少年提供免疫接种与其他预防服务之间取得平衡。找到提供免疫接种的成功方法以及有效的咨询和筛查将降低这一人群中疫苗可预防疾病的发病率，并将减少与青少年危险行为有关的更常见的发病率。

DESCRIPTION (provided by applicant): Immunizations for adolescents have become much more complex in recent years, with the licensure of a conjugate vaccine to prevent meningococcal disease, another vaccine to prevent human papillomavirus, and new tetanus toxoid-diphtheria-pertussis vaccine. Additional vaccine recommendations affecting adolescents are likely in the near future, including a recommendation for universal influenza vaccination and future development and licensure of vaccines to prevent cytomegalovirus, herpes simplex virus, and potentially Chlamydia trachomatis. In part due to the success of vaccination, the primary causes of morbidity and mortality during adolescence relate to preventable health behaviors, including tobacco, alcohol and drug use, risky sexual activity, mental health, and injury. Adolescent preventive services guidelines have been developed and endorsed by multiple professional organizations, including the American Medical Association (AMA), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the US Maternal and Child Health Bureau (MCHB) to guide physicians in providing preventive counseling and screening for these health issues. Yet it is unclear how physicians prioritize adolescent vaccine delivery along with clinical preventive services (CPS) delivery, and whether vaccine delivery enhances or impedes delivery of other preventive services. This project will assess family physicians' and pediatricians' knowledge, attitude towards and practice of adolescent preventive services delivery through key informant interviews and focus groups. We will also qualitatively evaluate how physicians in a variety of settings (urban, suburban, rural, underserved) and practice types (health maintenance organizations, private, clinic/community health center) prioritize CPS for adolescents, and we will assess potential methods to improve CPS delivery. To quantify the delivery of CPS and immunizations, we will perform chart reviews of 400 adolescents, and interview those adolescents (aged 11-14 and 15-18) and their parents (200 parents of those aged 11-14) in practices in upstate New York. These interviews will also improve our understanding of the attitudes of parents and adolescents toward CPS. The results of this project will guide future educational and practice-based strategies to increase rates of CPS and immunization delivery for adolescents. to Public Health Our project will explore how physicians are balancing the delivery of immunizations concurrently with other preventive services for adolescents. Finding successful methods for delivery of immunizations along with effective counseling and screening will decrease the rate of vaccine preventable diseases in this population, and will reduce the more common morbidities related to risky behaviors in adolescence.