Perkins Rebecca B, Zisblatt Lara, Legler Aaron, Trucks Emma, Hanchate Amresh, Gorin Sherri Sheinfeld
Boston University School of Medicine/Boston Medical Center, Department of Obstetrics and Gynecology, 85 E. Concord St 6th Floor Boston MA 02118, USA.
Boston University School of Medicine Continuing Medical Education, Boston MA, USA.
Vaccine. 2015 Feb 25;33(9):1223-9. doi: 10.1016/j.vaccine.2014.11.021. Epub 2014 Nov 24.
HPV vaccination is universally recommended for boys and girls, yet vaccination rates remain low nationwide.
We conducted a provider-focused intervention that included repeated contacts, education, individualized feedback, and strong quality improvement incentives to raise HPV vaccination rates at two federally qualified community health centers. To estimate the effectiveness of the intervention, rates of initiation of vaccination, and completion of the next needed HPV vaccination (dose 1, 2 or 3) among boys and girls ages 11-21 were compared at baseline and two follow-up periods in two intervention health centers (n4093 patients) and six control health centers (n9025 patients). We conducted multivariable logistic regression accounting for clustering by practice.
Girls and boys in intervention practices significantly increased HPV vaccine initiation during the active intervention period relative to control practices (girls OR 1.6, boys OR 11; p<0.001 for both). Boys at intervention practices were also more likely to continue to initiate vaccination during the post-intervention/maintenance period (OR 8.5; p<0.01). Girls and boys at intervention practices were more also likely to complete their next needed HPV vaccination (dose 1, 2 or 3) than those at control practices (girls OR 1.4, boys OR 23; p<0.05 for both). These improvements were sustained for both boys and girls in the post-intervention/maintenance period (girls OR 1.6, boys OR 25; p<0.05 for both).
Provider-focused interventions including repeated contacts, education, individualized feedback, and strong quality improvement incentives have the potential to produce sustained improvements in HPV vaccination rates.
人乳头瘤病毒（HPV）疫苗接种是普遍推荐给男孩和女孩的，但全国范围内的接种率仍然很低。
我们开展了一项以医疗服务提供者为重点的干预措施，包括反复联系、教育、个性化反馈以及强有力的质量改进激励措施，以提高两家联邦合格社区卫生中心的HPV疫苗接种率。为了评估干预措施的有效性，我们比较了两家干预性卫生中心（4093例患者）和六家对照卫生中心（9025例患者）中11至21岁男孩和女孩的疫苗接种起始率以及完成下一次所需HPV疫苗接种（第1、2或3剂）的情况。我们进行了多变量逻辑回归分析，并考虑了医疗机构的聚类情况。
与对照医疗机构相比，干预性医疗机构中的女孩和男孩在积极干预期间HPV疫苗接种起始率显著增加（女孩的优势比为1.6，男孩为11；两者p<0.001）。干预性医疗机构中的男孩在干预后/维持期也更有可能继续开始接种疫苗（优势比为8.5；p<0.01）。与对照医疗机构中的儿童相比，干预性医疗机构中的女孩和男孩也更有可能完成下一次所需的HPV疫苗接种（第1、2或3剂）（女孩优势比为1.4，男孩为23；两者p<0.05）。在干预后/维持期，男孩和女孩的这些改善情况都得以持续（女孩优势比为1.6，男孩为25；两者p<0.05）。
以医疗服务提供者为重点的干预措施，包括反复联系、教育、个性化反馈以及强有力的质量改进激励措施，有可能持续提高HPV疫苗接种率。
