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

Abstract

WHAT'S KNOWN ON THIS SUBJECT: The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children.WHAT THIS STUDY ADDS: AFIX consultations achieved short-term gains in coverage for 11-to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar. abstract OBJECTIVES: To assess the effectiveness of in-person and webinardelivered AFIX (Assessment, Feedback, Incentives, and eXchange) consultations for increasing adolescent vaccine coverage. METHODS:We randomly assigned 91 primary care clinics in North Carolina, serving 107 443 adolescents, to receive no consultation or an in-person or webinar AFIX consultation. We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011. The state' s immunization registry provided vaccine coverage data for younger patients (ages 11-12 years) and older patients (ages 13-18 years) for 3 adolescent vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); meningococcal; and human papillomavirus (HPV) vaccines ($1 dose, females only). RESULTS:At the 5-month follow-up, AFIX consultations increased vaccine coverage among younger adolescents. Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap (3.4% [95% confidence interval (CI): 2.2 to 4.6]), meningococcal (4.7% [95% CI: 2.3 to 7.2], and HPV (1.5% [95% CI: 0.3 to 2.7]) vaccines. Patients in the webinar versus control arm also experienced larger changes for these vaccines. AFIX did little to improve coverage among older adolescents. At 1 year, the 3 arms showed similar coverage changes. The effectiveness of in-person and webinar consultations was not statistically different at either time point (all, P ..05).CONCLUSIONS: Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents. AFIX consultations for adolescents need improvement to have a stronger and more durable impact, especially for HPV vaccine. Pediatrics 2014;134:e346-e353 AUTHORS:

Interventions to Improve Adolescent Vaccination

“…A follow-up study included 91 primary care clinics that were randomized to receive an in-person AFIX consultation, a virtual AFIX consultation, or no consultation. 88 At the 5-month follow-up assessment, it was found that the in person and virtual AFIX consultations were equally effective for improving adolescent vaccination, and both were better than no consultation. The impact of AFIX was greatest for younger adolescents, with vaccination levels among 11-12-year-olds 1.5%-4.7% higher in either AFIX arm (depending on the vaccine assessed) when compared with the control arm.…”

Interventions to Improve HPV Vaccine Uptake: A Systematic Review

“…HPV completion rates were highest among clinics that received an in-person AFIX consult. 38 Both authors commented on the high level of acceptability of the intervention by key stakeholders. Moss et al observed a small but statistically significant increase in series completion rates after a 1-time AFIX consultation over 1 month.…”

Practical Approaches to Optimize Adolescent Immunization

“…In a randomized controlled trial in North Carolina, AFIX improved immunization rates in 11-through 12-year-old adolescents by 3 to 4 percentage points for Tdap vaccine, by 4 to 5 percentage points for meningococcal vaccine, and by 2 percentage points for HPV vaccine initiation. 80 AFIX has highlighted that actual immunization rates in a practice might not mirror clinicians' perceptions of vaccine administration within their practice. To monitor immunization rates, a practice may periodically audit a sample of their patients.…”