The Effect of Clinical Decision Prompts in Improving Human Papillomavirus Vaccination Rates in a Multispecialty Practice in a Predominantly Hispanic Population: Quasi-Experimental Study.

IF 3.3 Q2 ONCOLOGY JMIR Cancer Pub Date : 2023-03-15 DOI:10.2196/42890
Jennifer Molokwu, Melissa Mendez, Christina Bracamontes
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引用次数: 0

Abstract

Background: The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age.

Objective: Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population.

Methods: We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015.

Results: We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96% vs 21.22%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7% and 58.36%; P<.001).

Conclusions: Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates.

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临床决策提示在多专业实践中提高人乳头瘤病毒疫苗接种率的作用:准实验研究。
背景:人乳头瘤病毒(HPV)与外阴、阴道、阴茎、子宫颈、肛门和口咽区癌症的病因通路有关。它是美国最常见的性传播感染。尽管有文献证明HPV疫苗的安全性和有效性,但接种率仍落后于同龄接种的其他疫苗。目的:医生推荐被认为是HPV疫苗摄取的一个强有力的预测因子,并且医生提示通常可以增加预防性保健服务的提供。从理论上讲,向提供者提供提醒应该增加提供HPV疫苗建议的机会,从而影响疫苗接种率。我们研究的目的是评估电子医疗记录(EMR)提示在一个学术诊所环境中提高HPV疫苗接种率的有效性,该诊所主要照顾西班牙裔边境人口。方法:我们采用准实验设计和回顾性图表审计来评估临床决策提示(CDP)对提高不同专业HPV疫苗接种率的影响。我们在德克萨斯州-墨西哥边境的一个大型多专业学术团体的妇产科(OBGYN)、儿科(PD)和家庭医学(FM)诊所中引入了一个电子病历提示,提醒提供者在看到合适的患者时推荐HPV疫苗。我们在引入提示前后评估了所有相关部门的HPV疫苗接种率。参与者包括2014年1月至2015年12月期间在诊所就诊的9至26岁的男性和女性患者。结果:我们回顾了所有3个诊所的2800多张图表。在调整了年龄、种族、种族、保险类型、首选语言和诊所后,免疫接种的几率为92%(结论:实施EMR CDP使我们的HPV疫苗接种完成的总体几率提高了92%)。我们推测,该决定提示提醒卫生保健提供者讨论或推荐HPV疫苗接种在临床服务提供。EMR中的CDPs有助于提高多个专业的HPV疫苗接种率,并且是提高疫苗接种率的低成本干预措施。
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来源期刊
JMIR Cancer
JMIR Cancer ONCOLOGY-
CiteScore
4.10
自引率
0.00%
发文量
64
审稿时长
12 weeks
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