Kulczycki Andrzej, Qu Haiyan, Shewchuk Richard
Department of Health Care Organization and Policy, Maternal and Child Heath Concentration, University of Alabama at Birmingham (UAB), 320 Ryals Public Health Bldg., 1665 University Blvd., Birmingham, AL, 35294-0022, USA.
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
Matern Child Health J. 2016 Dec;20(12):2539-2547. doi: 10.1007/s10995-016-2079-9.
Objectives We examined variation in primary care physicians' (PCPs') perceptions of barriers to physician-initiated discussion of HPV vaccination, and how this is associated with the rates at which they discuss, initiate and continue to administer vaccination with 11-12 year-old girls. Methods We surveyed 301 PCPs using systematic random sampling. PCP variation in perceived barriers to discussing HPV vaccination was modeled using latent class analysis (LCA). The distinct PCP groups identified were compared with each other using three iterative logistic regression models to predict the likelihood of initiating vaccine discussion and the reported percentages of 11-12 year-old patients who initiated HPV vaccination and received follow-up shots. Results LCA revealed three groups of PCPs who perceived major, moderately significant and relatively minor barriers (17.9, 41.9 and 40.2 % of respondents, respectively). Pediatricians, PCPs who were female, had minority racial/ethnic status and who perceived only minor barriers had significantly higher odds of initiating discussion. PCPs were more likely to initiate HPV vaccination if they had initiated discussion and perceived minor or moderate communication barriers. Increased likelihood to administer follow-up HPV vaccine was associated with having initiated discussion, perceiving only minor barriers and working outside Deep South states, but not with having initiated vaccination. Conclusions for Practice PCPs who discuss HPV vaccination with girls aged 11-12 and their mothers are more likely to start and sustain vaccine administration. However, different PCPs perceive barriers to discussion in different ways. Interventions tailored to different groups of PCPs should assist them in overcoming barriers to discussing their recommendations when necessary.
目标 我们研究了初级保健医生（PCP）对医生主动讨论人乳头瘤病毒（HPV）疫苗接种障碍的看法差异，以及这与他们与11至12岁女孩讨论、启动并持续进行疫苗接种的比率之间的关联。方法 我们采用系统随机抽样法对301名初级保健医生进行了调查。使用潜在类别分析（LCA）对初级保健医生在讨论HPV疫苗接种时所感知障碍的差异进行建模。使用三个迭代逻辑回归模型对所确定的不同初级保健医生群体进行相互比较，以预测启动疫苗讨论的可能性以及报告的11至12岁开始接种HPV疫苗并接受后续接种的患者百分比。结果 潜在类别分析揭示了三组初级保健医生，他们分别认为存在重大、中度显著和相对较小的障碍（分别占受访者的17.9%、41.9%和40.2%）。儿科医生、女性初级保健医生、少数族裔初级保健医生以及仅认为存在较小障碍的医生启动讨论的几率显著更高。如果初级保健医生已经启动讨论且认为存在较小或中度的沟通障碍，则他们更有可能启动HPV疫苗接种。增加接种后续HPV疫苗的可能性与已启动讨论、仅认为存在较小障碍以及在深南部州以外地区工作有关，但与已启动疫苗接种无关。实践结论 与11至12岁女孩及其母亲讨论HPV疫苗接种的初级保健医生更有可能开始并持续进行疫苗接种。然而，不同的初级保健医生对讨论障碍的看法各不相同。针对不同初级保健医生群体量身定制的干预措施应帮助他们在必要时克服讨论其建议时的障碍。
