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Coaching and Communication Training for HPV Vaccination: A Cluster Randomized Trial
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8 01 2022
Source: Pediatrics. 150(2) -
Alternative Title:Pediatrics
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Personal Author:
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Description:Background and objectives.
US health departments routinely conduct in-person quality improvement (QI) coaching to strengthen primary care clinics’ vaccine delivery systems, but this intervention achieves only small, inconsistent improvements in HPV vaccination. Thus, we sought to evaluate the effectiveness of combining QI coaching with remote provider communication training to improve impact.
Methods.
With health departments in 3 states, we conducted a pragmatic 4-arm cluster randomized clinical trial with 267 primary care clinics (76% pediatrics). We randomized clinics to receive in-person QI coaching, remote provider communication training, both interventions combined, or control. Using data from states’ immunization information systems, we prospectively assessed HPV vaccination among 176,189 patients, ages 11-17, who were unvaccinated at baseline. Our primary outcome was the proportion of those, ages 11-12, who had initiated HPV vaccination at 12-month follow-up.
Results.
HPV vaccine initiation was 1.5% points higher in the QI coaching arm and 3.8% points higher in the combined intervention arm than in the control arm, among patients ages 11-12, at 12-month follow-up (both p<0.001). These improvements persisted at 18-month follow-up. The combined intervention also achieved improvements for other age groups (ages 13-17) and vaccination outcomes (series completion). Remote communication training alone did not outperform the control on any outcome.
Conclusions.
Combining QI coaching with remote provider communication training yielded more consistent improvements in HPV vaccination uptake than QI coaching alone. Health departments and other organizations that seek to support primary care providers in HPV vaccine delivery may benefit from a higher intensity, multi-level intervention approach.
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Source:
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Pubmed ID:35818840
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Pubmed Central ID:PMC9535352
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