Reducing Missed Opportunities for Human Papillomavirus Vaccination in School-Based Health Centers: Impact of an Intervention
| Autor: | Kimberly E. Uyeda, L. Cindy Chang, Paul J. Chung, Megha D. Shah, Peter G. Szilagyi, Beth A. Glenn, Rebecca Valderrama |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Adolescent Post evaluation Alphapapillomavirus 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Intervention (counseling) Medicine Humans 030212 general & internal medicine Papillomavirus Vaccines School-based health centers Performance feedback Schools urogenital system business.industry Papillomavirus Infections Vaccination virus diseases Los Angeles Human papillomavirus vaccination Immunization Family medicine Relative risk Pediatrics Perinatology and Child Health business |
| Zdroj: | Academic pediatrics. 20(8) |
| ISSN: | 1876-2867 |
| Popis: | Human papillomavirus (HPV) immunization rates among US adolescents are low. Missed opportunities (MOs) for HPV vaccination are common. School-based health centers (SBHCs) have potential to boost HPV vaccination, but their role in addressing MOs has not been examined.We implemented a multicomponent intervention, consisting of 3 immunization process workflow modifications combined with provider performance feedback, in 2 Los Angeles area SBHCs and conducted a pre/post evaluation of MOs. Our primary outcome was SBHC-based MOs for HPV vaccination during all visits, including visits for confidential reproductive health care (ie, confidential visits). Secondary outcomes were MOs for meningococcal (MenACWY) and influenza vaccination during visits for nonconfidential care.MOs for HPV vaccination decreased during all visit types from the baseline to the intervention period (82.3% to 46.1%; adjusted risk ratio [RR] = 0.558, P.0001). The rate decrease appeared to be greater during physical examination visits than confidential visits (83.4% to 31.6% vs 98.7% to 70.4%, respectively). MOs for MenACWY (74.5% to 35.0%; adjusted RR = 0.47, P.0001) and influenza (86.7% to 69.3%; adjusted RR = 0.792, P.0001) vaccination also decreased during nonconfidential visits. Vaccine refusal was the most frequently documented reason for HPV vaccine MOs during both physical examination and confidential visits.A pragmatic, multicomponent SBHC intervention reduced MOs for HPV vaccination during all visit types. MOs for MenACWY and influenza vaccination also decreased during nonconfidential visits. Findings suggest that practice-level improvements in SBHCs can improve delivery of HPV and other adolescent vaccines. |
| Databáze: | OpenAIRE |
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