Frequent Vaccination Missed Opportunities at Primary Care Encounters Contribute to Underimmunization

Fu, Linda Y.; Zook, Kathleen; Gingold, Janet A.; Gillespie, Catherine W.; Briccetti, Christine; Cora‐Bramble, Denice; Joseph, Jill G.; Moon, Rachel Y.

doi:10.1016/j.jpeds.2014.10.066

Cited by 21 publications

(11 citation statements)

References 14 publications

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“…Also assessed was the proportion of visits where adolescents had a missed opportunity for vaccination, defined as a clinic visit during the study period at which an adolescent was eligible for an HPV vaccine dose but did not receive it. 31,32 Health Care Professional Use and Perceptions…”

Section: Heterogeneity Of Treatment Effectsmentioning

confidence: 99%

Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination

et al. 2018

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IMPORTANCE The incidence of human papillomavirus (HPV)-related cancers is more than 35 000 cases in the United States each year. Effective HPV vaccines have been available in the United States for several years but are underused among adolescents, the target population for vaccination. Interventions to increase uptake are needed. OBJECTIVE To evaluate the effect of a 5-component health care professional HPV vaccine communication intervention on adolescent HPV vaccination. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized clinical trial using covariate-constrained randomization to assign study arms and an intent-to-treat protocol was conducted in 16 primary care practices in the Denver, Colorado, metropolitan area. Participants included 188 medical professionals and 43 132 adolescents. INTERVENTIONS The 5 components of the intervention were an HPV fact sheet library to create customized information sheets relevant to each practice's patient population, a tailored parent education website, a set of HPV-related disease images, an HPV vaccine decision aid, and 2½ hours of communication training on using a presumptive vaccine recommendation, followed by motivational interviewing if parents were resistant to vaccination. Each practice participated in a series of 2 intervention development meetings over a 6-month period (August 1, 2014, to January 31, 2015) before the intervention. MAIN OUTCOMES AND MEASURES Differences between control and intervention changes over time (ie, difference in differences between the baseline and intervention period cohorts of patients) in HPV vaccine series initiation (Ն1 dose) and completion (Ն3 doses) among patients aged 11 to 17 years seen at the practices between February 1, 2015, and January 31, 2016. Vaccination data were obtained from the practices' records and augmented with state immunization information system data. RESULTS Sixteen practices and 43 132 patients (50.3% female; median age, 12.6 years [interquartile range, 10.8-14.7 years] at the beginning of the study period) participated in this trial. Adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.62) and completion (aOR, 1.56; 95% CI, 1.27-1.92) than those in the control practices (a 9.5-absolute percentage point increase in HPV vaccine series initiation and a 4.4-absolute percentage point increase in HPV vaccine series completion in intervention practices). The intervention had a greater effect in pediatric practices compared with family medicine practices and in private practices compared with public ones. Health care professionals reported that communication training and the fact sheets were the most used and useful intervention components. CONCLUSIONS AND RELEVANCE A health care professional communication intervention significantly improved HPV vaccine series initiation and completion among adolescent patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02456077

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Section: Heterogeneity Of Treatment Effectsmentioning

confidence: 99%

Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination

et al. 2018

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“…15 Making use of serendipitous or planned interactions between different child health VOLUME 9 • NUMBER 1 • MaRch 2017 J OURNAL OF PRIMARY HEALTH CARE providers can help increase opportunities to vaccinate. 16,17 New Zealand is privileged to have excellent data systems making feasible efficient outreach services working alongside regular general practice delivery. This study identified some excellent models of OIS and primary care working well together to achieve high immunisation coverage.…”

Section: Discussionmentioning

confidence: 99%

Outreach immunisation services in NewZealand: a review of service delivery models

et al. 2017

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INTRODUCTION Outreach Immunisation Services (OIS) enable children who have not been immunised on time at general practice to be immunised in the community, thereby improving immunisation coverage and reducing equity gaps. AIM To identify the most effective service delivery models and make recommendations for more effective and cost-efficient OIS delivery in New Zealand. METHODS Data collection and thematic analysis through a detailed review of OIS contracts and service specifications, an online survey and in-depth interviews with stakeholders and providers, and an analysis of cost data was conducted. RESULTS In total, 28 OIS providers completed survey questionnaires, 28 OIS staff were interviewed, and cost effectiveness data were obtained from 11 providers. The surveys and interviews identified key themes around identifying clients with the highest needs, effective engagement strategies, staffing requirements, and service challenges. On average, each OIS referral costs NZ$361 (median NZ$257), and each vaccination event costs NZ$636, ranging from NZ$145 to NZ$2403. Characteristics for two separate models of service delivery were identified based on provider size. CONCLUSION There is considerable range in costs and style of OIS delivery, and efficiencies can be gained. Models need to fit with locality needs and include adequate resourcing, staff with good local knowledge, close relationships with other key child health services and preferably co-location, sustainable funding, and regular service reviews. OIS are part of an effective integrated service that relies on accurate data, positive relationships and a rapid response when children fail to present for vaccination in a timely fashion.

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“…This is in line with findings from other studies of occurrence of missed vaccination opportunities. 24,25 To overcome this non-compliance, the present study indicates that it would be important to address vaccination providers' reluctance to give three injections at the same visit and their priority of following the sequence of vaccines.…”

Section: Health Consequences Of Delayed Vaccinationsmentioning

confidence: 92%

How are children who are delayed in the Childhood Vaccination Programme vaccinated: A nationwide register-based cohort study of Danish children aged 15–24 months and semi-structured interviews with vaccination providers

Holck

Jensen

et al. 2018

Scand J Public Health

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Frequent Vaccination Missed Opportunities at Primary Care Encounters Contribute to Underimmunization

Cited by 21 publications

References 14 publications

Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination

Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination

Outreach immunisation services in NewZealand: a review of service delivery models

How are children who are delayed in the Childhood Vaccination Programme vaccinated: A nationwide register-based cohort study of Danish children aged 15–24 months and semi-structured interviews with vaccination providers

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