临床医生对人乳头瘤病毒疫苗接种的知识、障碍以及感知到的家长障碍：与起始率和完成率的关联
Clinician knowledge, clinician barriers, and perceived parental barriers regarding human papillomavirus vaccination: Association with initiation and completion rates.
作者信息
Rutten Lila J Finney, St Sauver Jennifer L, Beebe Timothy J, Wilson Patrick M, Jacobson Debra J, Fan Chun, Breitkopf Carmen Radecki, Vadaparampil Susan T, Jacobson Robert M
机构信息
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Division of Health Policy and Management, School of Public Health, University of Minnesota, Mayo Building A302, 420 Delaware Street SE, Minneapolis, MN 55455, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
出版信息
Vaccine. 2017 Jan 3;35(1):164-169. doi: 10.1016/j.vaccine.2016.11.012. Epub 2016 Nov 23.
PURPOSE
We tested the hypothesis that clinician knowledge, clinician barriers, and perceived parental barriers relevant to the human papillomavirus (HPV) vaccination account for the variation in vaccine delivery at the practice-site level.
METHODS
We conducted a survey from October 2015 through January 2016 among primary care clinicians (n=280) in a 27-county geographic region to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination. Primary care clinicians included family medicine physicians, general pediatricians, and family and pediatric nurse-practitioners. We also used the Rochester Epidemiology Project to measure HPV vaccination delivery. Specifically we used administrative data to measure receipt of at least one valid HPV vaccine dose (initiation) and receipt of three valid HPV vaccine doses (completion) among 9-18year old patients residing in the same 27-county geographic region. We assessed associations of clinician survey data with variation in vaccine delivery at the clinical site using administrative data on patients aged 9-18years (n=68,272).
RESULTS
Consistent with our hypothesis, we found that greater knowledge of HPV and the HPV vaccination was associated with higher rates of HPV vaccination initiation (Incidence rate ratio [IRR]=1.05) and completion of three doses (IRR=1.28). We also found support for the hypothesis that greater perceived parental barriers to the HPV vaccination were associated with lower rates of initiation (IRR=0.94) and completion (IRR=0.90). These IRRs were statistically significant even after adjustment for site-level characteristics including percent white, percent female, percent ages 9-13, and percent with government insurance or self-pay at each site.
CONCLUSIONS
Clinician knowledge and their report of the frequency of experiencing parental barriers are associated with HPV vaccine delivery rates-initiation and completion. Higher measures of knowledge correlated with higher rates. Fewer perceived occurrences of parental barriers correlated with lower rates. These data can guide efforts to improve HPV vaccine delivery in clinical settings.
目的
我们检验了这样一个假设，即临床医生的知识、临床医生面临的障碍以及家长所察觉到的与人类乳头瘤病毒（HPV）疫苗接种相关的障碍，可以解释在医疗机构层面上疫苗接种率的差异。
方法
2015年10月至2016年1月，我们在一个涵盖27个县的地理区域内，对基层医疗临床医生（n = 280）进行了一项调查，以评估临床医生对HPV疫苗接种的知识、面临的障碍以及家长所察觉到的障碍。基层医疗临床医生包括家庭医学医生、普通儿科医生以及家庭和儿科执业护士。我们还利用罗切斯特流行病学项目来衡量HPV疫苗接种情况。具体而言，我们使用行政数据来衡量居住在同一27个县地理区域内9至18岁患者中至少接种一剂有效HPV疫苗（起始接种）和接种三剂有效HPV疫苗（全程接种）的情况。我们使用9至18岁患者（n = 68,272）的行政数据，评估临床医生调查数据与临床机构疫苗接种差异之间的关联。
结果
与我们的假设一致，我们发现对HPV及HPV疫苗接种了解更多，与更高的HPV疫苗起始接种率（发病率比[IRR]=1.05）和三剂全程接种率（IRR=1.28）相关。我们还发现有证据支持这一假设，即家长对HPV疫苗接种所察觉到的障碍越大，起始接种率（IRR=0.94）和全程接种率（IRR=0.90）越低。即使在对各机构层面的特征进行调整后，包括白人百分比、女性百分比、9至13岁年龄组百分比以及各机构中拥有政府保险或自费患者的百分比，这些发病率比仍具有统计学意义。
结论
临床医生的知识以及他们所报告的家长障碍出现频率，与HPV疫苗接种率（起始接种和全程接种）相关。知识水平越高，接种率越高。察觉到的家长障碍出现次数越少，接种率越低。这些数据可为改善临床环境中HPV疫苗接种工作提供指导。
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