a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.
b Center for Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.
Hum Vaccin Immunother. 2019;15(7-8):1784-1793. doi: 10.1080/21645515.2019.1581554. Epub 2019 Apr 11.
Understanding physician recommendation practices for HPV vaccination is a crucial step to developing interventions that can increase high quality recommendations and improve vaccination acceptance. Florida physicians ( = 340) completed a survey assessing recommendation strategies, specifically strength, consistency, and presentation. Physicians were also asked to provide suggestions for improving HPV vaccination in Florida. Responses were dichotomized for each outcome: strength (i.e., strongly recommend vs. other), consistently recommend (i.e., always recommend vs. other), and recommendation presentation (i.e., presented in the same manner as mandatory vaccines for adolescents vs. other). Bivariate logistic regression was conducted to determine the association between physician/practice characteristics and each outcome. Variables significant ( < .05) in bivariate analyses were included in multivariable logistic regression analyses. Vaccines for Children (VFC) provider status (OR = 2.62, 95% CI = 1.23-5.59 [strong]; OR = 2.84, 95% CI = 1.26-6.39 [consistent]) and not limiting the number of vaccines during a visit (OR = .283, 95% = CI .111-.722 [strong]; OR = .210, 95% = CI .066-.673 [consistent]) were significantly associated with strong and consistent recommendation. Reminders from the healthcare team were associated with consistency (OR = 2.26, 95% CI = 1.23-4.16) and EMR-based reminders were associated with presentation (OR = 2.00, 95% CI = 1.11-3.61). Multinomial logistic regression analysis examined factors associated with level of engagement in recommendation strategies. Multinomial regression indicated VFC providers (OR = 12.61, 95% CI = 1.89-82.20), and those receiving EMR-based reminders (OR = 4.02, 95% = CI 1.28-12.63), among others, were more likely to engage in all 3 types of recommendation practices. Physician suggestions for improving HPV vaccination rates included improving parent/patient/provider education and reducing vaccine costs. Future interventions should emphasize key components of delivering effective HPV vaccine recommendations, include information about insurance coverage, and improve provider awareness of VFC benefits.
了解医生推荐 HPV 疫苗接种的做法是制定干预措施的关键步骤，这些措施可以提高高质量的推荐并改善疫苗接种的接受度。佛罗里达州的医生（= 340）完成了一项调查，评估了推荐策略，特别是强度、一致性和呈现方式。医生还被要求提供改善佛罗里达州 HPV 疫苗接种的建议。对每个结果进行二分法处理：强度（即强烈推荐与其他）、一致性推荐（即始终推荐与其他）和推荐呈现（即与青少年强制性疫苗相同的方式呈现与其他）。进行了二元逻辑回归分析，以确定医生/实践特征与每个结果之间的关联。在双变量分析中具有统计学意义（<.05）的变量被纳入多变量逻辑回归分析。疫苗为儿童（VFC）提供者身份（OR = 2.62，95%CI = 1.23-5.59 [强]；OR = 2.84，95%CI = 1.26-6.39 [一致]）和在就诊期间不限制疫苗数量（OR = 0.283，95%CI =.111-722 [强]；OR = 0.210，95%CI =.066-673 [一致]）与强烈和一致的推荐显著相关。医疗团队的提醒与一致性相关（OR = 2.26，95%CI = 1.23-4.16），基于 EMR 的提醒与呈现相关（OR = 2.00，95%CI = 1.11-3.61）。多项逻辑回归分析检查了与推荐策略参与程度相关的因素。多项回归分析表明，VFC 提供者（OR = 12.61，95%CI = 1.89-82.20）和接受基于 EMR 的提醒者（OR = 4.02，95%CI = 1.28-12.63）等，更有可能参与所有 3 种推荐实践。医生提高 HPV 疫苗接种率的建议包括改善家长/患者/提供者教育和降低疫苗成本。未来的干预措施应强调提供有效 HPV 疫苗接种建议的关键组成部分，包括有关保险范围的信息，并提高提供者对 VFC 益处的认识。
