Berenson Abbey B, Hirth Jacqueline M, Kuo Yong-Fang, Starkey Jonathan M, Rupp Richard E
Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA.
Preventive Medicine & Population Health, Office of Biostatistics and Epidemiology, University of Texas Medical Branch, USA.
Prev Med Rep. 2020 Aug 28;20:101194. doi: 10.1016/j.pmedr.2020.101194. eCollection 2020 Dec.
A patient navigator (PN) program was implemented in pediatric clinics to increase uptake of the human papillomavirus (HPV) vaccine. The purpose of this study is to examine the impact of this program. All visits between April 1, 2013 and December 31, 2017 for 9-17 year old patients at 3 program and 5 non-program clinics were examined using electronic medical records. These dates included patient visits before and after program initiation (February 1, 2015). Visits including 1 dose of the HPV vaccine were assessed as a proportion of total visits for each month. Multivariable binary logistic regression was used to examine the odds of HPV vaccination across time, between program and non-program clinics, and age group. A total of 128,051 visits by 21,395 patients were examined. HPV vaccines were administered during 12,742 visits (10.0%). Odds of HPV vaccination during visits by 13-17 year olds was greater than during visits by 9-12 year olds in the pre-intervention period (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.19). However, this association changed during the intervention period, with odds of HPV vaccination among visits by 13-17 year olds lower compared to visits by 9-12 year olds (OR: 0.78, 95% CI: 0.75-0.82). The odds of HPV vaccination were elevated among 9-12 year olds in program clinics as compared to 2014, the year before the program was implemented. Having on-site PNs can increase the frequency of HPV vaccination in pediatric clinics, particularly among patients 9-12 years of age.
在儿科诊所实施了患者导航员（PN）项目，以提高人乳头瘤病毒（HPV）疫苗的接种率。本研究的目的是检验该项目的影响。利用电子病历对2013年4月1日至2017年12月31日期间3个项目诊所和5个非项目诊所中9至17岁患者的所有就诊情况进行了检查。这些日期包括项目启动前（2015年2月1日）和启动后的患者就诊。将包含1剂HPV疫苗的就诊情况评估为每个月总就诊情况的比例。采用多变量二元逻辑回归分析来检验不同时间、项目诊所与非项目诊所之间以及年龄组的HPV疫苗接种几率。共检查了21395名患者的128051次就诊情况。在12742次就诊（10.0%）中接种了HPV疫苗。在干预前期，13至17岁患者就诊时的HPV疫苗接种几率高于9至12岁患者就诊时的几率（优势比[OR]：1.12，95%置信区间[CI]：1.04 - 1.19）。然而，在干预期这种关联发生了变化，13至17岁患者就诊时的HPV疫苗接种几率低于9至12岁患者就诊时的几率（OR：0.78，95%CI：0.75 - 0.82）。与项目实施前的2014年相比，项目诊所中9至12岁患者的HPV疫苗接种几率有所提高。配备现场PN可提高儿科诊所HPV疫苗的接种频率，尤其是在9至12岁的患者中。
