Zimmerman Richard K, Nowalk Mary Patricia, Lin Chyongchiou Jeng, Hannibal Kristin, Moehling Krissy K, Huang Hsin-Hui, Matambanadzo Annamore, Troy Judith, Allred Norma J, Gallik Greg, Reis Evelyn C
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Vaccine. 2014 Jun 17;32(29):3656-63. doi: 10.1016/j.vaccine.2014.04.057. Epub 2014 Apr 29.
To increase childhood influenza vaccination rates using a toolkit and early vaccine delivery in a randomized cluster trial.
Twenty primary care practices treating children (range for n=536-8183) were randomly assigned to Intervention and Control arms to test the effectiveness of an evidence-based practice improvement toolkit (4 Pillars Toolkit) and early vaccine supplies for use among disadvantaged children on influenza vaccination rates among children 6 months-18 years. Follow-up staff meetings and surveys were used to assess use and acceptability of the intervention strategies in the Intervention arm. Rates for the 2010-2011 and 2011-2012 influenza seasons were compared. Two-level generalized linear mixed modeling was used to evaluate outcomes.
Overall increases in influenza vaccination rates were significantly greater in the Intervention arm (7.9 percentage points) compared with the Control arm (4.4 percentage points; P<0.034). These rate changes represent 4522 additional doses in the Intervention arm vs. 1390 additional doses in the Control arm. This effect of the intervention was observed despite the fact that rates increased significantly in both arms - 8/10 Intervention (all P<0.001) and 7/10 Control sites (P-values=0.04 to <0.001). Rates in two Intervention sites with pre-intervention vaccination rates >58% did not significantly increase. In regression analyses, a child's likelihood of being vaccinated was significantly higher with: younger age, white race (Odds ratio [OR]=1.29; 95% confidence interval [CI]=1.23-1.34), having commercial insurance (OR=1.30; 95%CI=1.25-1.35), higher pre-intervention practice vaccination rate (OR=1.25; 95%CI=1.16-1.34), and being in the Intervention arm (OR=1.23; 95%CI=1.01-1.50). Early delivery of influenza vaccine was rated by Intervention practices as an effective strategy for raising rates.
Implementation of a multi-strategy toolkit and early vaccine supplies can significantly improve influenza vaccination rates among children in primary care practices but the effect may be less pronounced in practices with moderate to high existing vaccination rates. Clinical trial registry name/number: From Innovation to Solutions: Childhood Influenza/NCT01664793.
在一项随机整群试验中，使用工具包和早期疫苗供应来提高儿童流感疫苗接种率。
将20家治疗儿童的基层医疗诊所（n范围为536 - 8183）随机分为干预组和对照组，以测试基于证据的实践改进工具包（四支柱工具包）和为弱势儿童提供的早期疫苗供应对6个月至18岁儿童流感疫苗接种率的有效性。通过后续的员工会议和调查来评估干预组中干预策略的使用情况和可接受性。比较了2010 - 2011年和2011 - 2012年流感季节的接种率。使用二级广义线性混合模型来评估结果。
与对照组（4.4个百分点；P<0.034）相比，干预组的流感疫苗接种率总体增幅显著更大（7.9个百分点）。这些接种率变化在干预组相当于增加了4522剂疫苗，而对照组增加了1390剂。尽管两组的接种率均显著上升——干预组10个中有8个（所有P<0.001），对照组10个中有7个（P值 = 0.04至<0.001），但仍观察到了干预的效果。干预前接种率>58%的两个干预组诊所的接种率没有显著增加。在回归分析中，儿童接种疫苗的可能性显著更高的因素有：年龄较小、白人种族（优势比[OR]=1.29；95%置信区间[CI]=1.23 - 1.34）、拥有商业保险（OR=1.30；95%CI=1.25 - 1.35）、干预前诊所接种率较高（OR=1.25；95%CI=1.16 - 1.34）以及在干预组（OR=1.23；95%CI=1.01 - 1.50）。干预组诊所将早期提供流感疫苗评为提高接种率的有效策略。
实施多策略工具包和早期疫苗供应可显著提高基层医疗诊所儿童的流感疫苗接种率，但在现有接种率中等至高的诊所中，效果可能不太明显。临床试验注册名称/编号：从创新到解决方案：儿童流感/NCT01664793。
