Sturm Lynne, Donahue Kelly, Kasting Monica, Kulkarni Amit, Brewer Noel T, Zimet Gregory D
Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
J Adolesc Health. 2017 Aug;61(2):246-251. doi: 10.1016/j.jadohealth.2017.02.006. Epub 2017 Apr 25.
We sought to establish which human papillomavirus (HPV) vaccine communication approaches by pediatricians were associated with same-day HPV vaccination of 11- to 12-year-olds by evaluating audio recordings of visits.
Verilogue, a market research company maintaining a panel of primary care pediatricians, provided audio recordings and transcriptions of well-child visits for 11- to 12-year-old patients from January through June 2013. Seventy-five transcripts from 19 pediatricians were coded for use of presumptive language (i.e., words conveying assumption of vaccine delivery), offer of delay, recommendation strength, and information provision. Using logistic regression, we evaluated the association between pediatrician communication approaches and agreement to same-day HPV vaccination. Generalized estimating equations accounted for clustering of patients within pediatricians.
Same-day agreement to HPV vaccination occurred in 29% of encounters. Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine (73% vs. 22%; odds ratio = 8.96; 95% confidence interval = 2.32-34.70). Pediatricians offered or recommended delay in most encounters (65%). HPV vaccine acceptance occurred far more often when pediatricians did not mention delaying vaccination (82% vs. 6%; odds ratio = 80.84; 95% confidence interval = 15.72-415.67). Same-day vaccination was not associated with strength of recommendation or pediatrician reference to vaccinating their own children.
Our findings highlight the need to develop and evaluate physician-focused trainings on using presumptive language for same-day HPV vaccination.
我们试图通过评估就诊的音频记录，确定儿科医生采用的哪些人乳头瘤病毒（HPV）疫苗沟通方式与11至12岁儿童当日接种HPV疫苗相关。
Verilogue是一家拥有基层儿科医生小组的市场研究公司，提供了2013年1月至6月11至12岁患者健康儿童就诊的音频记录和文字记录。对来自19名儿科医生的75份文字记录进行编码，以确定是否使用了推定语言（即传达疫苗接种假设的词汇）、是否提供延迟接种、推荐强度以及信息提供情况。我们使用逻辑回归评估儿科医生沟通方式与当日HPV疫苗接种同意率之间的关联。广义估计方程考虑了儿科医生内部患者的聚类情况。
29%的就诊中出现了当日接种HPV疫苗的同意情况。样本中的儿科医生经常向家长传达不一致、含混的信息，有时提供的关于HPV或HPV疫苗接种的信息不准确。在75次就诊中，儿科医生仅在11次中使用了推定语言；使用推定时，与接受HPV疫苗的较高几率相关（73%对22%；优势比=8.96；95%置信区间=2.32-34.70）。在大多数就诊中（65%），儿科医生提供或建议延迟接种。当儿科医生未提及延迟接种时，HPV疫苗接种接受率要高得多（82%对6%；优势比=80.84；95%置信区间=15.72-415.67）。当日接种与推荐强度或儿科医生提及给自己孩子接种疫苗无关。
我们的研究结果凸显了开展和评估以医生为重点的培训的必要性，该培训内容为使用推定语言进行当日HPV疫苗接种。
