Gregory Zimet1, Brian E Dixon2, Shan Xiao3, Wanzhu Tu4, Amit Kulkarni5, Tamara Dugan6, Meena Sheley6, Stephen M Downs7. 1. Department of Pediatrics-Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Ind. Electronic address: gzimet@iu.edu. 2. Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, Ind; The Regenstrief Institute, Indianapolis, Ind. 3. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Ind. 4. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Ind; The Regenstrief Institute, Indianapolis, Ind. 5. Merck and Co, Kenilworth, NJ. 6. Department of Pediatrics-Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Ind. 7. Department of Pediatrics-Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Ind; The Regenstrief Institute, Indianapolis, Ind.
Abstract
OBJECTIVE: To evaluate the effects of simple and elaborated health care provider (HCP) reminder prompts on human papillomavirus (HPV) vaccine initiation rates. METHODS:Twenty-nine pediatric HCPs serving 5 pediatric clinics were randomized to 1 of 3 arms: 1) usual practice control, 2) simple reminder prompt, and 3) elaborated reminder prompt, which included suggested language for recommending the early adolescent platform vaccines. Prompts were delivered via a computer-based clinical decision support system deployed in the 5 clinics. Eligible patients were ages 11 to 13 years, had not received HPV vaccine, and were due for meningococcal ACWY (MenACWY) vaccine and/or the tetanus, diphtheria, and pertussis booster (Tdap). Receipt of HPV vaccine was determined via automated queries sent to the Indiana immunization registry. Data were analyzed via logistic regression models, with generalized estimating equations used to account for the clustering of patients within HCPs. RESULTS: Ten HCPs in the control group saw 301 patients, 8 HCPs in the simple prompt group saw 124, and 11 HCPs in the elaborated prompt group saw 223. The elaborated prompt arm had a higher rate of HPV vaccination (62%) than the control arm (45%): adjusted odds ratio, 2.76; 95% confidence interval, 1.07 to 7.14. The simple prompt arm did not differ significantly from the control arm with respect to HPV vaccine initiation, which might have been because of the small sample size for this arm. MenACWY and Tdap rates did not vary across the 3 arms. CONCLUSIONS: Results suggest that an elaborated HCP-targeted reminder prompt, with suggested recommendation language, might improve rates of HPV vaccine initiation.
RCT Entities:
OBJECTIVE: To evaluate the effects of simple and elaborated health care provider (HCP) reminder prompts on human papillomavirus (HPV) vaccine initiation rates. METHODS: Twenty-nine pediatric HCPs serving 5 pediatric clinics were randomized to 1 of 3 arms: 1) usual practice control, 2) simple reminder prompt, and 3) elaborated reminder prompt, which included suggested language for recommending the early adolescent platform vaccines. Prompts were delivered via a computer-based clinical decision support system deployed in the 5 clinics. Eligible patients were ages 11 to 13 years, had not received HPV vaccine, and were due for meningococcal ACWY (MenACWY) vaccine and/or the tetanus, diphtheria, and pertussis booster (Tdap). Receipt of HPV vaccine was determined via automated queries sent to the Indiana immunization registry. Data were analyzed via logistic regression models, with generalized estimating equations used to account for the clustering of patients within HCPs. RESULTS: Ten HCPs in the control group saw 301 patients, 8 HCPs in the simple prompt group saw 124, and 11 HCPs in the elaborated prompt group saw 223. The elaborated prompt arm had a higher rate of HPV vaccination (62%) than the control arm (45%): adjusted odds ratio, 2.76; 95% confidence interval, 1.07 to 7.14. The simple prompt arm did not differ significantly from the control arm with respect to HPV vaccine initiation, which might have been because of the small sample size for this arm. MenACWY and Tdap rates did not vary across the 3 arms. CONCLUSIONS: Results suggest that an elaborated HCP-targeted reminder prompt, with suggested recommendation language, might improve rates of HPV vaccine initiation.
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