Clinician Prompts for Human Papillomavirus Vaccination: A Cluster Randomized Trial.

adolescent vaccination human papillomavirus vaccine primary care pediatrics provider reminder

Journal

Academic pediatrics
ISSN: 1876-2867
Titre abrégé: Acad Pediatr
Pays: United States
ID NLM: 101499145

Informations de publication

Date de publication:
02 Nov 2023
Historique:
received: 31 07 2023
revised: 24 10 2023
accepted: 27 10 2023
pubmed: 5 11 2023
medline: 5 11 2023
entrez: 4 11 2023
Statut: aheadofprint

Résumé

We assessed the impact of an online intervention using clinician prompts for human papillomavirus (HPV) vaccination with a cluster randomized controlled trial. The randomized trial occurred July 2021-January 2022 in 48 primary care pediatric practices (24 intervention, 24 control) across the US. We trained clinicians via two online learning modules, plus weekly ''quick tips'' delivered via text or email. The training taught practices to implement a staff prompt to the clinician (e.g., printed reminders placed on the keyboard) plus electronic health record (EHR) prompts (if not already done) at well and acute/chronic visits for initial and subsequent HPV vaccination. We assessed missed opportunities for HPV vaccination using logistic regression models accounting for clustering by practice on an intent to treat basis. Surveys assessed facilitators and barriers to using prompts. During the 6-month intervention, missed opportunities for HPV vaccination increased (worsened) in both intervention and control groups. However, at well child care visits, missed opportunities for the initial HPV vaccine increased by 4.5 (95% CI: -9.0%, -0.1%) percentage points less in intervention versus control practices. Change in missed opportunities for subsequent doses at well child care and non-well child care visits did not differ between trial groups. An end-of trial survey found understaffing as a common challenge. Clinician prompts reduced missed opportunities for HPV vaccination at well child care visits. Understaffing related to the COVID-19 pandemic may have led to worsening missed opportunities for both groups and likely impeded practices in fully implementing changes.

Identifiants

DOI: 10.1016/j.acap.2023.10.011 PMID: 37925070
pubmed: 37925070
pii: S1876-2859(23)00401-1
doi: 10.1016/j.acap.2023.10.011
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest Dr. Humiston has the following conflicts of interest: until 9/2022, Dr. Humiston’s employer received grant money for her work sponsored by the Pediatric Infectious Diseases Society (PIDS) Foundation, a not-for-profit organization. PIDS is funded for the project through unrestricted joint educational grants from Sanofi US, Merck & Co., Inc., Pfizer, Inc., GlaxoSmithKline, and Seqirus USA, Inc.

Auteurs

Cynthia M Rand (CM)

Department of Pediatrics (CM Rand), University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address: cynthia_rand@urmc.rochester.edu.

Alisa J Stephens-Shields (AJ)

Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.

Mary K Kelly (MK)

Clinical Futures (MK Kelly and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa.

Russell Localio (R)

Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.

Chloe Hannan (C)

Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.

Robert W Grundmeier (RW)

Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Biomedical and Health Informatics (RW Grundmeier and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa.

Laura P Shone (LP)

Shone Sciences (LP Shone), DBA, Lowville, NY.

Jennifer Steffes (J)

Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill; Primary Care Research (J Steffes and K Davis), American Academy of Pediatrics, Itasca, Ill.

Kristin Davis (K)

Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill; Primary Care Research (J Steffes and K Davis), American Academy of Pediatrics, Itasca, Ill.

Christina Albertin (C)

Department of Pediatrics (C Albertin), University of California at Los Angeles, Mattel Children's Hospital, Los Angeles, Calif.

Sharon G Humiston (SG)

Department of Pediatrics (SG Humiston and PG Szilagyi), Children's Mercy Hospital, Kansas City, Mo.

Greta McFarland (G)

Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill.

Dianna E Abney (DE)

Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill.

Peter G Szilagyi (PG)

Department of Pediatrics (SG Humiston and PG Szilagyi), Children's Mercy Hospital, Kansas City, Mo.

Alexander G Fiks (AG)

Clinical Futures (MK Kelly and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Biomedical and Health Informatics (RW Grundmeier and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa; Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill.

Classifications MeSH