Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG5, Indianapolis, IN, 46202, USA.
Regenstrief Institute, Inc., Center for Biomedical Informatics, 1101 W. 10th St, Indianapolis, IN, 46202, USA.
BMC Med Inform Decis Mak. 2017 Aug 10;17(1):119. doi: 10.1186/s12911-017-0521-6.
Human Papillomavirus (HPV) leads to serious health issues and remains the most common sexually transmitted infection. Despite availability of effective vaccines, HPV vaccination rates are suboptimal. Furthermore, providers recommend the HPV vaccine less than half the time for eligible patients. Prior informatics research has demonstrated the effectiveness of computer-based clinical decision support (CDS) in changing provider behavior, especially in the area of preventative services.
Following a randomized clinical trial to test the effect of a CDS intervention on HPV vaccination rates, we conducted semi-structured interviews with health care providers to understand whether they noticed the CDS reminders and why providers did or did not respond to the prompts. Eighteen providers, a mix of medical doctors and nurse practitioners, were interviewed from five publicly-funded, urban health clinics. Interview data were qualitatively analyzed by two independent researchers using inductive content analysis.
While most providers recalled seeing the CDS reminders, few of them perceived the intervention as effective in changing their behavior. Providers stated many reasons for why they did not perceive a change in their behavior, yet the results of the trial showed HPV vaccination rates increased as a result of the intervention.
CDS reminders may be effective at changing provider behavior even if providers perceive them to be of little use.
ClinicalTrials.gov Identifier: NCT02551887 Registered on September 15, 2015.
人乳头瘤病毒（HPV）可导致严重的健康问题，仍是最常见的性传播感染。尽管有有效的疫苗，但 HPV 疫苗接种率仍不理想。此外，提供者为符合条件的患者推荐 HPV 疫苗的比例还不到一半。先前的信息学研究已经证明了基于计算机的临床决策支持（CDS）在改变提供者行为方面的有效性，尤其是在预防服务领域。
在一项针对 CDS 干预对 HPV 疫苗接种率影响的随机临床试验之后，我们对医疗保健提供者进行了半结构化访谈，以了解他们是否注意到 CDS 提醒，以及提供者为何对提示做出或未做出回应。从五个公共资助的城市健康诊所中采访了 18 名提供者，其中包括医生和护士从业者。两名独立研究人员使用归纳内容分析法对访谈数据进行了定性分析。
尽管大多数提供者都记得看到过 CDS 提醒，但他们很少有人认为该干预措施对改变他们的行为有效。提供者陈述了他们为什么没有感觉到行为发生变化的许多原因，但试验结果表明，由于干预措施，HPV 疫苗接种率有所增加。
即使提供者认为 CDS 提醒用处不大，它们也可能有效改变提供者的行为。
ClinicalTrials.gov 标识符：NCT02551887 于 2015 年 9 月 15 日注册。
