Dang Julie H T, Stewart Susan L, Blumberg Dean A, Rodriguez Hector P, Chen Moon S
Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA.
Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, University of California , Sacramento, CA, USA.
Hum Vaccin Immunother. 2020 Aug 2;16(8):1814-1823. doi: 10.1080/21645515.2019.1710410. Epub 2020 Feb 12.
Acceptance of the human papillomavirus (HPV) vaccination among parents and clinicians is high, but uptake remains low. Little is known about organizational and primary care team factors that influence the uptake of the HPV vaccine. Interviews with clinicians, clinic support staff, and parents of adolescent patients were conducted to better understand the interrelationships among the people and the organizational processes that influence HPV vaccine uptake at the point of care. Between July 2016 and February 2017, semi-structured interviews of 40 participants (18 clinicians, 12 clinic support staff, and 10 parents of adolescent patients) in a primary care network were conducted. Organizational structures and processes, such as electronic provider reminders, availability of "vaccination only" appointments, and knowledgeable primary care team members contributed to HPV vaccine uptake. Consistently high support of HPV vaccination was found among key informants; however, rather than refuse HPV vaccination, parents are opting to delay vaccination to a future visit. When parents express the desire to delay, clinicians and care team members described often recommending addressing HPV vaccination at a future visit, giving parents the impression that receiving the vaccine was not time-sensitive for their child. Discordance in HPV vaccination recommendations among providers and clinic support staff may contribute to delayed HPV vaccination. Strong, high-quality HPV vaccine recommendations are needed from all primary team members. Clinic interventions to accelerate HPV vaccine uptake may benefit from a team-based approach where every member of the primary care team is delivering the same consistent messaging about the importance of timely HPV vaccination.
家长和临床医生对人乳头瘤病毒（HPV）疫苗的接受度很高，但接种率仍然很低。关于影响HPV疫苗接种的组织因素和基层医疗团队因素，我们知之甚少。为了更好地理解在医疗服务点影响HPV疫苗接种的人员与组织流程之间的相互关系，我们对临床医生、诊所支持人员以及青少年患者的家长进行了访谈。在2016年7月至2017年2月期间，我们对一个基层医疗网络中的40名参与者（18名临床医生、12名诊所支持人员和10名青少年患者的家长）进行了半结构化访谈。诸如电子提供者提醒、“仅接种疫苗”预约的可获得性以及知识渊博的基层医疗团队成员等组织结构和流程有助于HPV疫苗的接种。关键信息提供者对HPV疫苗接种一直给予高度支持；然而，家长们并非拒绝接种HPV疫苗，而是选择推迟到未来的就诊时接种。当家长表示希望推迟接种时，临床医生和护理团队成员通常会建议在未来的就诊时进行HPV疫苗接种，这让家长们觉得为孩子接种疫苗对时间要求不高。提供者和诊所支持人员之间在HPV疫苗接种建议上的不一致可能导致HPV疫苗接种延迟。所有基层医疗团队成员都需要给出有力、高质量的HPV疫苗接种建议。加速HPV疫苗接种的诊所干预措施可能会受益于一种基于团队的方法，即基层医疗团队的每个成员都就及时接种HPV疫苗的重要性传递一致的信息。
