Comparing in-person and webinar delivery of an immunization quality improvement program: a process evaluation of the adolescent AFIX trial

Abstract

BackgroundImmunization quality improvement programs are often limited by the cost and inconvenience associated with delivering face-to-face consultations to primary care providers. To investigate a more efficient mode of intervention delivery, we conducted a process evaluation that compared in-person consultations to those delivered via interactive webinar.MethodsThe Centers for Disease Control and Prevention’s Assessment, Feedback, Incentives, and eXchange (AFIX) Program is an immunization quality improvement program implemented in all 50 states. In 2011, we randomly assigned 61 high-volume primary care clinics in North Carolina to receive an in-person or webinar AFIX consultation focused on adolescent immunization. We used surveys of participating vaccine providers and expense tracking logs to evaluate delivery modes on participation, satisfaction, and cost. Clinics served 71,874 patients, ages 11 to 18.ResultsClinics that received in-person and webinar consultations reported similar levels of participation on key programmatic activities with one exception: more webinar clinics reported improving documentation of previously administered, ‘historical’ vaccine doses. Both in-person and webinar clinics showed sustained improvement in confidence to use reminder/recall systems (both p < 0.05). Participants rated delivery modes equally highly on satisfaction measures such as convenience (mean = 4.6 of 5.0). Delivery cost per clinic was $152 for in-person consultations versus $100 for webinar consultations.ConclusionsIn-person and webinar delivery modes were both well received, but webinar AFIX consultations cost substantially less. Interactive webinar delivery shows promise for considerably extending the reach of immunization quality improvement programs.Trial registrationClinicaltrials.gov, NCT01544764

Expanding Cessation Pharmacotherapy Via Videoconference Educational Outreach to Prescribers

“…One randomized study of a single session intervention delivered in-person or via webinar using Adobe Connect (Adobe Systems Incorporated) demonstrated that there was no difference in effectiveness between delivery via Adobe Connect and the in-person delivery, and they both appeared to be satisfactory to clinicians. 40 Two factors related to prescribing to disadvantaged smokers with mental illness (e.g., those with low education, income or employment) could have influenced our findings. First, this study addressed smokers with mental illness disabilities whose income is typically quite low, such that these smokers typically do not feel they can afford to buy NRT over the counter in pharmacies.…”

Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial

“…This finding suggests that an interactive webinar is a viable way to deliver AFIX without incurring travel costs. In a separate process evaluation, 8 we calculated the cost of delivering our intervention as $152 per clinic for in-person consultations versus $100 per clinic for webinar consultations. Future studies should seek to replicate our findings in the context of early childhood AFIX because webinar delivery could significantly improve the efficiency of this nationally implemented program.…”

“…Our intervention has been described in detail elsewhere, 8 but briefly, each clinic received 1 in-person AFIX consultation (delivered April-May 2011), 1 AFIX consultation by webinar (delivered May-August 2011), or no consultation. During the consultation, which consisted of a single 60-to 90-minute session, an immunization specialist (A.M.D.)…”

Interventions to Improve Adolescent Vaccination

“…A process evaluation comparing the in-person and virtual AFIX strategies demonstrated that the latter was significantly less expensive ($100 vs $152 per clinic). 89 …”