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Albers AN, Wright E, Thaker J, Conway K, Daley MF, Newcomer SR. Childhood Vaccination Practices and Parental Hesitancy Barriers in Rural and Urban Primary Care Settings. J Community Health 2023; 48:798-809. [PMID: 37119349 PMCID: PMC10148012 DOI: 10.1007/s10900-023-01226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/01/2023]
Abstract
The purpose of our study was to identify primary care providers' (PCPs') practices in promoting childhood vaccination and their perceptions regarding barriers to vaccination in a primarily rural state. In January-May 2022, we conducted a mail and online survey of PCPs across Montana (n = 829). The survey included modules on routine immunizations in children 0-2 years old and COVID-19 vaccination in children 5-17 years old. The survey response rate was 36% (298/829). We categorized PCPs as working in rural (n = 218) or urban areas (n = 80), based on Rural-Urban Commuting Area codes. We then compared responses between rural and urban PCPs using chi-square tests. Urban PCPs (90-94%, depending on vaccine) stocked routinely recommended vaccines more frequently than rural PCPs (71-84%), but stocked the COVID-19 vaccine less often than rural PCPs (44% vs. 71%, respectively, p < 0.001). A higher percentage of rural providers reported parental beliefs that vaccine-preventable diseases are not severe enough to warrant vaccination (48% vs. 31%, p = 0.01) and concerns that vaccination will weaken their child's immune system (29% vs. 6%, p < 0.001). More rural (74%) compared to urban (59%) PCPs identified a social media campaign from local health departments promoting early childhood vaccinations as an effective strategy to increase childhood vaccination rates (p = 0.01). We identified key differences in some childhood vaccination practices and barriers between rural and urban PCPs. Interventions to increase rural vaccination rates could include increasing the number of providers stocking all recommended vaccines, identifying strategies to address parents' concerns regarding vaccine necessity, and collaborations with public health departments.
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Affiliation(s)
- Alexandria N Albers
- Center for Population Health Research, University of Montana, Missoula, MT, USA.
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.
- , 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Emma Wright
- Family Medicine Residency of Western Montana, University of Montana, Missoula, MT, USA
- Partnership Health Center, Missoula, MT, USA
| | - Juthika Thaker
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Kathrene Conway
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sophia R Newcomer
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
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Albers AN, Thaker J, Newcomer SR. Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature. Prev Med Rep 2022; 27:101804. [PMID: 35656229 PMCID: PMC9152779 DOI: 10.1016/j.pmedr.2022.101804] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/23/2022] [Accepted: 04/18/2022] [Indexed: 12/22/2022] Open
Abstract
Early childhood vaccination rates are lower in rural areas of the U.S. compared with suburban and urban areas. Our aim was to identify barriers to and facilitators of early childhood immunization in rural U.S. communities. We completed a systematic review of original research conducted in the U.S. between January 1, 2000-July 25, 2021. We searched PubMed, Cumulative Index for Nursing and Allied Health Literature, and Web of Science. We included studies that examined barriers to and facilitators of routine immunizations in children <36 months old in rural areas. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we reported studies' methodologies and targeted populations, definitions of rurality, and common themes across studies that reflected barriers to or facilitators of vaccination. Ultimately, 17 papers met inclusion criteria for review. The majority of studies (10/17) were conducted within one U.S. state, and the same number (10/17) were conducted prior to 2005. Facilitators of vaccine uptake in rural communities identified across studies included reminder/recall systems and parents' relationships with providers. Parental hesitancy, negative clinic experiences, referrals outside of primary care settings, and distance to providers were identified as barriers to vaccination in rural settings. This review revealed a limited scope of evidence on barriers to and facilitators of early childhood immunization in rural communities. More investigations of the causes of low vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed in rural pediatric populations to address persistent rural-urban immunization disparities.
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Affiliation(s)
- Alexandria N. Albers
- University of Montana, School of Public and Community Health Sciences, 32 Campus Drive, Missoula, MT, USA
- University of Montana, Center for Population Health Research, 32 Campus Drive, Missoula, MT, USA
| | - Juthika Thaker
- University of Montana, School of Public and Community Health Sciences, 32 Campus Drive, Missoula, MT, USA
- University of Montana, Center for Population Health Research, 32 Campus Drive, Missoula, MT, USA
| | - Sophia R. Newcomer
- University of Montana, School of Public and Community Health Sciences, 32 Campus Drive, Missoula, MT, USA
- University of Montana, Center for Population Health Research, 32 Campus Drive, Missoula, MT, USA
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Singh P, Dhalaria P, Kashyap S, Soni GK, Nandi P, Ghosh S, Mohapatra MK, Rastogi A, Prakash D. Strategies to overcome vaccine hesitancy: a systematic review. Syst Rev 2022; 11:78. [PMID: 35473819 PMCID: PMC9044888 DOI: 10.1186/s13643-022-01941-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Vaccination, albeit a necessity in the prevention of infectious diseases, requires appropriate strategies for addressing vaccine hesitancy at an individual and community level. However, there remains a glaring scarcity of available literature in that regard. Therefore, this review aims to scrutinize globally tested interventions to increase the vaccination uptake by addressing vaccine hesitancy at various stages of these interventions across the globe and help policy makers in implementing appropriate strategies to address the issue. METHODS A systematic review of descriptive and analytic studies was conducted using specific key word searches to identify literature containing information about interventions directed at vaccine hesitancy. The search was done using PubMed, Global Health, and Science Direct databases. Data extraction was based on study characteristics such as author details; study design; and type, duration, and outcome of an intervention. RESULTS A total of 105 studies were identified of which 33 studies were included in the final review. Community-based interventions, monetary incentives, and technology-based health literacy demonstrated significant improvement in the utilization of immunization services. On the other hand, media-based intervention studies did not bring about a desired change in overcoming vaccine hesitancy. CONCLUSION This study indicates that the strategies should be based on the need and reasons for vaccine hesitancy for the targeted population. A multidimensional approach involving community members, families, and individuals is required to address this challenging issue.
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Affiliation(s)
- Prem Singh
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Pritu Dhalaria
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | | | - Gopal Krishna Soni
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Partha Nandi
- Department of Community Medicine, College of Medicine, University of Bisha - Ministry of Higher Education, Bisha, Kingdom of Saudi Arabia
| | - Shreeparna Ghosh
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Mrinal Kar Mohapatra
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Apurva Rastogi
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Divya Prakash
- Institute of Medical Sciences and SUMS Hospital, Bhubaneswar, Odisha, India
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Jong KM, Sikora CA, MacDonald SE. Childhood immunization appointment reminders and recalls: strengths, weaknesses and opportunities to increase vaccine coverage. Public Health 2021; 194:170-175. [PMID: 33951552 DOI: 10.1016/j.puhe.2021.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Childhood immunization coverage has been shown to be greatly impacted by parental forgetfulness regarding immunizations and appointments. Evidence supports the use of reminders and recalls to overcome this barrier, which remind parents about upcoming immunization appointments and inform them once their child is overdue for an immunization. In this study, we sought to identify reminder/recall strategies used throughout a large Canadian province and determine the perceived strengths, weaknesses and areas of improvement of existing strategies. STUDY DESIGN AND METHODS An environmental scan was performed in 2018 in two phases: (1) interviews with public health leaders from the five zones of Alberta and (2) an online survey of public health centres across the province. Data analysis occurred in 2018 and 2019. RESULTS Commonly reported strengths of reminders and recalls included their ability to increase appointment attendance and remind parents about immunizations, respectively. A major identified weakness was their time-consuming/resource-intensive nature. Many participants believed reminder/recalls could be improved by modernizing delivery methods. Educational information or strategies to overcome language barriers were rarely incorporated into reminder/recall systems. CONCLUSIONS There was support for incorporating text messaging and automation into reminder/recall systems while encouraging continued exploration of novel reminder/recall delivery methods. Tailoring reminder/recalls to the needs and preferences of target populations can maximize the effectiveness of these systems. This includes modernizing methods of delivery, addressing language barriers, providing educational information, and allotting some degree of flexibility to local level management of reminder/recalls.
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Affiliation(s)
- K M Jong
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - C A Sikora
- Alberta Health Services, Edmonton, Alberta, Canada; Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - S E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
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Kempe A, Stockwell MS, Szilagyi P. The Contribution of Reminder-Recall to Vaccine Delivery Efforts: A Narrative Review. Acad Pediatr 2021; 21:S17-S23. [PMID: 33958086 DOI: 10.1016/j.acap.2021.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/27/2022]
Abstract
Reminders, alerting patients to the need for vaccines that will be due in the future, and recall messages, informing patients about vaccines that are overdue, have been shown to improve immunization rates for children and adolescents in numerous systematic reviews. Therefore, reminder and recall interventions (R/R) are recommended by the Task Force on Community Preventive Services for increasing immunization rates on the basis of strong evidence. R/R messages can be delivered by mail (letter or postcard), via personal or auto-dialer phone calls, by text or e-mail or via patient-portals and can simply be alerts to action or can include educational material with the aim of motivating patients to seek vaccination. R/R has also been shown to be a relatively low-cost intervention with high cost-effectiveness compared with other recommended strategies. However, although R/R as a strategy is consistently effective and cost-effective overall, there is wide variation in the impact of R/R by 1) modality of how it is delivered, 2) the targeted vaccine, 3) the age group, and 4) whether the R/R is conducted centrally by a health system or Immunization Information System or by individual practices. This narrative review summarizes the literature about effectiveness of R/R within each of these categories. We also discuss limitations of R/R, with a focus on the potential impact of parental vaccine hesitancy in blunting its effectiveness and problems with data integrity, on which R/R relies. We also discuss challenges to sustaining R/R efforts, including potential methods of funding for R/R efforts.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (A Kempe), Aurora, Colo.
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center (MS Stockwell), New York, NY; Department of Population and Family Health, Columbia University Irving Medical Center (MS Stockwell), New York, NY
| | - Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (P Szilagyi)
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Saville AW, Gurfinkel D, Beaty BL, Chi AE, Dayton A, Hurley L, Suresh K, Kempe A. The potential for centralized reminder/recall to increase immunization rates: A national survey of immunization information systems (IIS) managers. Prev Med Rep 2021; 21:101296. [PMID: 33489724 PMCID: PMC7808944 DOI: 10.1016/j.pmedr.2020.101296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022] Open
Abstract
Little is known about Immunization Information System (IIS) attitudes and experiences using Centralized IIS-based Reminder/Recall (CI-R/R), an effective approach to increasing immunization rates. To describe among IIS managers as it relates to CI-R/R: 1) past experiences and future plans conducting it; 2) attitudes and barriers, 3) IIS capabilities and polices that influence, and 4) factors that differentiate IIS who have and have not conducted CI-R/R. Electronic Surveys were sent to all IIS managers in July 2018 using a member listserve. Fifty-seven of 62 IIS programs contacted (92%) responded. The majority (61%) had ever conducted CI-R/R; 34% reported they were "very likely" to conduct CI-R/R within 6 months. The majority (64%) were in favor of CI-R/R. Barriers included lack of staff (78%), competing demands (76%), and cost (63%). Thirty percent reported receiving a ≥75% of immunization data via real-time electronic interfaces (HL7). Overall, 49% and 24% of jurisdictions had mandatory immunization reporting from private and public health entities for childhood and adult immunizations, respectively. Differences between IIS that ever and never performed CI-R/R, respectively, included: mandatory reporting from private and public entities for children (65% v 27%, p = 0.006), having a legal mandate for CI-R/R (50% v 19%, p = 0.02), less likely to prefer practice-based R/R to CI-R/R (68% v. 91%, p = 0.04), and not reporting having too many competing demands (29% v 67%, p = 0.007). Most IIS have conducted CI-R/R and have positive attitudes towards it. Given it effectiveness and low cost, efforts to sustain it should be considered.
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Affiliation(s)
- Alison W. Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Brenda L. Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Alison E. Chi
- American Immunization Registry Association (AIRA), Washington, DC, United States
| | - Amanda Dayton
- American Immunization Registry Association (AIRA), Washington, DC, United States
| | - Laura Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
- Denver Health and Hospital Authority, Denver, CO, United States
| | - Krithika Suresh
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
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Effect of vaccine reminder and tracker bracelets on routine childhood immunization coverage and timeliness in urban Pakistan (2017-18): a randomized controlled trial. BMC Public Health 2020; 20:1086. [PMID: 32652969 PMCID: PMC7353686 DOI: 10.1186/s12889-020-09088-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background Inability to track children’s vaccination history coupled with parents’ lack of awareness of vaccination due dates compounds the problem of low immunization coverage and timeliness in developing countries. We evaluated the impact of two types of silicone immunization reminder bracelets for children in improving immunization coverage and timeliness of Pentavalent-3 and the Measles-1 vaccines. Methods Children < 3 months were enrolled in either of the 2 intervention groups (Alma Sana Bracelet Group and Star Bracelet Group) or the Control group. Children in the intervention groups were provided the two different bracelets at the time of recruitment. Each time the child visited the immunization center, a hole was perforated in the silicone bracelet to denote vaccine administration. Each child was followed up till administration of Measles-1 vaccine or till 12 months of age (if they did not come to the center for vaccination). Data was analyzed using the intention-to-treat population between groups. The unadjusted and adjusted Risk Ratios (RR) and 95% confidence interval (CI) for Pentavalent-3 and Measles-1 coverage at 12 months of age were estimated through bivariate and multivariate analysis. Time-to-Pentavalent-3 and Measles-1 immunization curves were calculated using the Kaplan–Meier method. Results A total of 1,445 children were enrolled in the study between July 19, 2017 and October 10, 2017. Baseline characteristics among the three groups were similar. Up-to-date coverage for the Pentavalent-3 /Measles-1 vaccine at 12 months of age was 84.6%/72.0%, 85.4%/70.5% and 83.0%/68.5% in Alma Sana Bracelet group, Star Bracelet group and Control group respectively but the differences were not statistically significant. In the multivariate analysis, neither the Alma Sana bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06), (adjusted RR: 1.05; 95% CI: 0.97-1.13) nor the Star bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06) (adjusted RR: 1.03; 95% CI: 0.95-1.11) was significantly associated with Pentavalent-3 vaccination or Measles-1 vaccination. Conclusion Although we did not observe any significant impact of the bracelets on improved immunization coverage and timeliness, our findings add to the existing literature on innovative, low cost reminders for health and make several suggestions for enhancing practical implementation of these tools. Trial registration ClinicalTrials.gov NCT03310762. Retrospectively Registered on October 16, 2017.
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Szilagyi PG, Albertin C, Casillas A, Valderrama R, Duru OK, Ong MK, Vangala S, Tseng CH, Rand CM, Humiston SG, Evans S, Sloyan M, Lerner C. Effect of Patient Portal Reminders Sent by a Health Care System on Influenza Vaccination Rates: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:962-970. [PMID: 32421168 PMCID: PMC7235900 DOI: 10.1001/jamainternmed.2020.1602] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022]
Abstract
Importance Influenza vaccination rates across the US are low. Because few practices send patient reminders for influenza vaccination, a scalable patient reminder system is needed. Objective To evaluate the effect of patient reminders sent via a health care system's electronic health record patient portal on influenza vaccination rates. Design, Setting, and Participants This pragmatic, 4-arm randomized clinical trial was performed from October 1, 2018, to March 31, 2019, across the UCLA (University of California, Los Angeles) health care system. A total of 164 205 patients in 52 primary care practices who had used the patient portal within 12 months were included. Interventions Patients due for an influenza vaccine were sent a letter via the patient portal of the health care system reminding them about the importance of influenza vaccination, safety of the vaccine, and morbidity associated with influenza. Patients were randomized within primary care practices to 1 of 4 study groups (no reminder [n = 41 070] vs 1 reminder [n = 41 055], 2 reminders [n = 41 046], or 3 reminders [n = 41 034]). Main Outcomes and Measures The primary outcome was receipt of 1 or more influenza vaccines as documented in the electronic health record, which was supplemented with influenza vaccination data from external sources (eg, pharmacies). Secondary outcomes were influenza vaccination rates among subgroups and influenza vaccinations self-reported by patients in reply to the portal-based query as having been received elsewhere. Results A total of 164 205 patients (mean [SD] age, 46.2 [19.6] years; 95 779 [58.3%] female) were randomly allocated to 1 of the 4 study arms. In the primary analysis across all ages and not including patient self-reported vaccinations in reply to portal reminders, influenza vaccination rates were 37.5% for those receiving no reminders, 38.0% for those receiving 1 reminder (P = .008 vs no reminder), 38.2% for those receiving 2 reminders (P = .03 vs no reminder), and 38.2% for those receiving 3 reminders (P = .02 vs no reminder). In the secondary analysis not including patient self-reported vaccinations, among adults aged 18 to 64 years (vaccination rates: 32.0% in the control group, 32.8% in the 1-reminder group, 32.8% in the 2-reminder group, and 32.8% in the 3-reminder group; P = .001), male patients (vaccination rates: 37.3% vs 38.3%, 38.6%, and 38.8%; P = .001), non-Hispanic patients (vaccination rates: 37.6% vs 38.2%, 38.3%, and 38.2%; P = .004), and those who were not vaccinated in the prior 2 years (vaccination rates: 15.3% vs 15.9%, 16.3%, and 16.1%; P < .001), vaccination rates were higher in the portal reminder groups than in the control group; the findings in these 3 subgroups mirrored the findings in the entire population. When self-reported vaccinations received elsewhere were included, influenza vaccination rates were 1.4 to 2.9 percentage points higher in the portal reminder groups, with a dose-response effect (0 reminders: 15 537 [37.8%]; 1 reminder: 16 097 [39.2%]; 2 reminders: 16 426 [40.0%]; and 3 reminders: 16 714 [40.7%]; P < .001). Conclusions and Relevance Generic patient portal reminders were effective in minimally increasing influenza vaccination rates, but more intensive or more targeted patient motivational strategies appear to be needed. Trial Registration ClinicalTrials.gov Identifier: NCT03666026.
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Affiliation(s)
- Peter G. Szilagyi
- Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children's Hospital, UCLA
| | - Christina Albertin
- Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children's Hospital, UCLA
| | | | - Rebecca Valderrama
- Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children's Hospital, UCLA
| | - O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, UCLA
| | - Michael K. Ong
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Fielding School of Public Health, Department of Health Policy and Management, UCLA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, UCLA
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, David Geffen School of Medicine, UCLA
| | - Cynthia M. Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Sharon Evans
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Carlos Lerner
- Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children's Hospital, UCLA
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Fisher MP, Gurfinkel D, Szilagyi PG, Saville A, Albertin C, Breck A, Valderrama R, Kempe A. Supporting and sustaining centralized reminder/recall for immunizations: Qualitative insights from stakeholders. Vaccine 2019; 37:6601-6608. [PMID: 31562003 DOI: 10.1016/j.vaccine.2019.09.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022]
Abstract
Centralized reminder/recall (C-R/R) is an evidence-based strategy for increasing vaccination rates that uses a population-level database such as a state immunization information system (IIS) to send notifications across large geographic areas. IISs are usually based in state public health departments, which could initiate C-R/R. While C-R/R is a promising strategy, the factors influencing its initiation and sustainment are not clear. Utilizing qualitative content analysis methodology and interviews with key stakeholders involved in or knowledgeable about C-R/R, we examined the characteristics of these initiatives and factors influencing their success. We identified and spoke with managers and senior leaders across IISs, health plans, health systems, pharmaceutical companies, and advocacy organizations and focused especially on C-R/R activities within IISs. Several considerations were determined important to C-R/R success: decision-making, stakeholder buy-in, partnerships, funding, data and technology, evaluation, and message content. Salient barriers were costs and lack of funding, poor contact data quality (i.e. telephone number, home address), and messaging that is either overly broad or too specific. Pertinent facilitators of C-R/R included notifying health providers in advance of an initiative, conducting a rigorous post-reminder/recall evaluation, and engaging a range of partners. Partnerships were important to stakeholders for multiple reasons including technical assistance, resource sharing, and sharing of best practices. Overall, our results illustrate the many opportunities to advance C-R/R through further collaboration within and across public health departments and potentially via public-private partnerships.
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Affiliation(s)
- Michael P Fisher
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los, Angeles, Los Angeles, California, USA.
| | - Alison Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los, Angeles, Los Angeles, California, USA.
| | - Abigail Breck
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los, Angeles, Los Angeles, California, USA.
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los, Angeles, Los Angeles, California, USA
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
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Gianfredi V, Moretti M, Lopalco PL. Countering vaccine hesitancy through immunization information systems, a narrative review. Hum Vaccin Immunother 2019; 15:2508-2526. [PMID: 30932725 PMCID: PMC6930057 DOI: 10.1080/21645515.2019.1599675] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/06/2019] [Accepted: 03/15/2019] [Indexed: 01/02/2023] Open
Abstract
Immunization is one of the most important public health interventions to contrast infectious disease; however, many people nowadays refuse vaccination. Vaccine hesitancy (VH) is due to several factors that influence the complex decision-making process. Information technology tools might play an important role in vaccination programs. In particular, immunization information systems (IISs) have the potential to improve performance of vaccination programs and to increase vaccine uptake. This review aimed to present IIS functionalities in order to counter VH. In detail, we analyzed the automatic reminder/recall system, the interoperability of the system, the decision support system, the web page interface and the possibility to record adverse events following immunization. IIS could concretely represent a valid instrument to increase vaccine confidence, especially trust in both health-care workers and decision makers. There are not enough trials aimed to evaluate the efficacy of IIS to counter VH. Further researches might focalize on this aspect.
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Affiliation(s)
- Vincenza Gianfredi
- Post-Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Massimo Moretti
- Department of Pharmaceutical Science, Unit of Public Health, University of Perugia, Perugia, Italy
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Kahn KE, Santibanez TA, Zhai Y, Bridges CB. Association between patient reminders and influenza vaccination status among children. Vaccine 2018; 36:8110-8118. [PMID: 30448063 PMCID: PMC6419731 DOI: 10.1016/j.vaccine.2018.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patient reminders are recommended to increase vaccination rates. The objectives of this study were to estimate the percentage of children 6 months-17 years for whom a patient reminder for influenza vaccination was received by a child's parent or guardian, estimate influenza vaccination coverage by receipt of a patient reminder, and identify factors associated with receipt of a patient reminder. METHODS National Immunization Survey-Flu (NIS-Flu) data for the 2013-14 influenza season were analyzed. Tests of association between patient reminders and demographic characteristics were conducted using Wald chi-square tests and pairwise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receiving a patient reminder. RESULTS Approximately 22% of children had a parent or guardian report receiving a patient reminder for influenza vaccination for their child, ranging from 12.9% in Idaho to 41.2% in Mississippi. Children with a patient reminder were more likely to be vaccinated compared with children without a patient reminder (73.7% versus 55.5%). In the multivariable model, reminder receipt was higher for children 6-23 months compared with children 13-17 years, black children compared with white children, and children whose parent completed the survey in English compared with children whose parent completed the survey in a language other than English or Spanish. CONCLUSIONS Although patient reminders are associated with a higher likelihood of influenza vaccination, nationally, less than one-fourth of children had a parent report receiving one. Despite being based on parental report, with its limitations, this study suggests that increasing the number of parents who receive patient reminders for their children may improve vaccination coverage among children.
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Affiliation(s)
- Katherine E Kahn
- Leidos, Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Yusheng Zhai
- Leidos, Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn B Bridges
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Berry Technology Solutions, Inc., Peachtree City, GA, USA
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12
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Reeves SL, Jary HK, Gondhi JP, Kleyn M, Wagner AL, Dombkowski KJ. Pneumococcal vaccination coverage among children with sickle cell anemia, sickle cell trait, and normal hemoglobin. Pediatr Blood Cancer 2018; 65:e27282. [PMID: 29905397 DOI: 10.1002/pbc.27282] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/02/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Children with sickle cell anemia and sickle cell trait are at an increased risk of invasive pneumococcal disease compared to children with normal hemoglobin. We assessed and compared pneumococcal vaccination status among these three groups. PROCEDURE Children with sickle cell anemia and sickle cell trait were identified using Michigan newborn screening records (1997-2014); each child was matched to four children with normal hemoglobin based on age, Medicaid enrollment (at least 1 year from 2012-2014), race, and census tract. Vaccination records were obtained from the state's immunization system. Pneumococcal vaccine coverage (PCV7 or PCV13 depending on date of administration) was assessed at milestone ages of 3, 5, 7, and 16 months. The proportion of children with vaccine coverage at each milestone was calculated overall and compared among children with sickle cell anemia, sickle cell trait, and normal hemoglobin using chi-square tests. RESULTS The study population consisted of 355 children with sickle cell anemia, 17,319 with sickle cell trait, and 70,757 with normal hemoglobin. The proportion of children with age-appropriate pneumococcal vaccination coverage was low at each milestone and generally decreased over time. Children with sickle cell anemia were more likely to be covered compared to children with sickle cell trait or normal hemoglobin. CONCLUSIONS Despite higher pneumococcal vaccination coverage among children with sickle cell anemia, opportunities for improvement exist among all children. Targeted interventions will benefit from mechanisms to identify children with increased risks such as sickle cell anemia or trait to improve pneumococcal vaccination coverage among these groups.
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Affiliation(s)
- Sarah L Reeves
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Hannah K Jary
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Jennifer P Gondhi
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Mary Kleyn
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Kevin J Dombkowski
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
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13
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Bondurant KL, Wheeler JG, Bursac Z, Holmes T, Tilford JM. Comparison of Office-Based Versus Outsourced Immunization Recall Services. Clin Pediatr (Phila) 2017; 56:555-563. [PMID: 27798388 DOI: 10.1177/0009922816673307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Given poor use of recall in primary care practices, we compared outsourced versus office-based recall systems. STUDY DESIGN From 2011 to 2013, we enrolled 87 individual Arkansas providers in distinct practices treating their own patients <24 months of age which were randomized to usual care (A), office-based (B), or outsourced (C) recall groups. RESULTS At the end of study, recall activity was 19.4%, 55.0%, and 92.6% for Groups A, B, and C, respectively (B and C vs A: P < .001). Only 68 Group B patients were identified as needing immunizations versus 826 in Group C. The majority of successful contacts were made through mobile phone (41.3%) or text message (32.6%). The total cost per practice per week was significantly lower for Group C versus Group B ($39.50 and $53.00, respectively; P = .004). CONCLUSIONS With limited electronic health record use, an outsourced recall system is more sustainable and less costly than an office-based system.
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Affiliation(s)
| | - J Gary Wheeler
- 2 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,3 Arkansas Department of Health, Little Rock, AR, USA
| | - Zoran Bursac
- 4 University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tereasa Holmes
- 1 Arkansas Foundation for Medical Care, Little Rock, AR, USA
| | - J Mick Tilford
- 2 University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Patel S, Hemmige V, Street RL, Viswanath K, Arya M. Activating Racial and Ethnic Minorities to Engage in Preventive Health: Patient Preferences for Health Reminders. J Particip Med 2017; 9:e8. [PMID: 29270330 PMCID: PMC5736376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVES The objective of this study was to determine racial and ethnic minority patient receptiveness to health reminders, and preferences for media channels and messengers for preventive health reminders. METHODS A pen and paper survey was administered to patients in the waiting room of a publicly funded clinic serving predominately racial and ethnic minorities. RESULTS Three-fourths of participants said they would like to receive health reminders. The top three preferred methods of receiving health reminders were via text message, phone call, and letter by mail. About half of participants wanted their doctor or nurse to send them the health reminder. CONCLUSIONS Health reminders could be a tool to successfully encourage racial and ethnic minority patients to participate in their own health. If physicians or nurses use a cell phone text message, a phone call, or a letter to send these health reminders they may be particularly effective at improving patient health outcomes.
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Affiliation(s)
- Sajani Patel
- Address: 10518 Windwalker Trail Houston, TX 77095; Telephone: 713-409-9304
| | - Vagish Hemmige
- Address: 6620 Main Street, #1375, Houston, TX 77030; Telephone: 713-798-2900
| | - Richard L Street
- Address: Houston VA Medical Center (Mailstop 152), 2002 Holcombe Blvd, Houston, TX 77030
| | - Kasisomayajula Viswanath
- Address: Dana-Farber Cancer Institute, 450 Brookline Avenue, LW 601, Boston, Massachusetts 02215; Telephone: 617.632.2225
| | - Monisha Arya
- Address: Houston VA Medical Center (Mailstop 152), 2002 Holcombe Blvd, Houston, TX 77030; Telephone: 713 794-8601
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15
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Kempe A, Saville AW, Beaty B, Dickinson LM, Gurfinkel D, Eisert S, Roth H, Herrero D, Trefren L, Herlihy R. Centralized Reminder/Recall to Increase Immunization Rates in Young Children: How Much Bang for the Buck? Acad Pediatr 2017; 17:330-338. [PMID: 27913163 DOI: 10.1016/j.acap.2016.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We compared the effectiveness and cost-effectiveness of: 1) centralized reminder/recall (C-R/R) using the Colorado Immunization Information System (CIIS) versus practice-based reminder/recall (PB-R/R) approaches to increase immunization rates; 2) different levels of C-R/R intensity; and 3) C-R/R with versus without the name of the child's provider. METHODS We conducted 3 sequential cluster-randomized trials involving children aged 19 to 25 months in 15 Colorado counties in March 2013 (trial 1), October 2013 (trial 2), and May 2014 (trial 3). In C-R/R counties, the intensity of the intervention decreased sequentially in trials 1 through 3, from 3 to 1 recall messages. In PB-R/R counties, practices were offered training using CIIS and financial support. The percentage of children with up-to-date (UTD) vaccinations was compared 6 months after recall. A mixed-effects model assessed the association between C-R/R versus PB-R/R and UTD rates. RESULTS C-R/R was more effective in trials 1 to 3 (relative risk = 1.11; 95% confidence interval 1.01-1.20; P = .009). Effectiveness did not decrease with decreasing intervention intensity (P = .59). Costs decreased with decreasing intensity in the C-R/R arm, from $18.72 per child brought UTD in trial 1 to $10.11 in trial 3. Costs were higher and more variable in the PB-R/R arm, ranging from $20.63 to $237.81 per child brought UTD. C-R/R was significantly more effective if the child's practice name was included (P < .0001). CONCLUSIONS C-R/R was more effective and cost-effective than PB-R/R for increasing UTD rates in young children and was most effective if messages included the child's provider name. Three reminders were not more effective than one, which may be explained by the increasing accuracy of contact information in CIIS over the course of the trials.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Denver, Colo.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo
| | - Brenda Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo
| | - L Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo; Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, Colo
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, and The Children's Hospital, Denver, Colo
| | - Sheri Eisert
- Department of Health Policy and Management and Department of Pediatrics, University of South Florida, Tampa, Fla
| | - Heather Roth
- Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo
| | - Diana Herrero
- Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo
| | - Lynn Trefren
- Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo
| | - Rachel Herlihy
- Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colo
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16
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Rand CM, Vincelli P, Goldstein NPN, Blumkin A, Szilagyi PG. Effects of Phone and Text Message Reminders on Completion of the Human Papillomavirus Vaccine Series. J Adolesc Health 2017; 60:113-119. [PMID: 27836533 DOI: 10.1016/j.jadohealth.2016.09.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the effect of phone or text message reminders to parents of adolescents on human papillomavirus (HPV) vaccine series completion in Rochester, NY. METHODS We performed parallel randomized controlled trials of phone and text reminders for HPV vaccine for parents of 11- to 17-year olds in three urban primary care clinics. The main outcome measures were time to receipt of the third dose of HPV vaccine and HPV vaccination rates. RESULTS We enrolled 178 phone intervention (180 control) and 191 text intervention (200 control) participants. In multivariate survival analysis controlling for gender, age, practice, insurance, race, and ethnicity, the time from enrollment to receipt of the third HPV dose for those receiving a phone reminder compared with controls was not significant overall (hazard ratio [HR] = 1.30, p = .12) but was for those enrolling at dose 1 (HR = 1.91, p = .007). There was a significant difference in those receiving a text reminder compared with controls (HR = 2.34, p < .0001; an average of 71 days earlier). At the end of the study, 48% of phone intervention versus 40% of phone control (p = .34), and 49% of text intervention versus 30% of text control (p = .001) adolescents had received 3 HPV vaccine doses. CONCLUSIONS In this urban population of parents of adolescents, text message reminders for HPV vaccine completion for those who had already started the series were effective, whereas phone message reminders were only effective for those enrolled at dose 1.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Phyllis Vincelli
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nicolas P N Goldstein
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Aaron Blumkin
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, California
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17
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Smith PJ, Stokley S, Bednarczyk RA, Orenstein WA, Omer SB. HPV vaccination coverage of teen girls: the influence of health care providers. Vaccine 2016; 34:1604-1610. [PMID: 26854907 PMCID: PMC7285619 DOI: 10.1016/j.vaccine.2016.01.061] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Between 2010 and 2014, the percentage of 13-17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine ("fully vaccinated") increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine ("not immunized") decreased by 11.3 percentage points to 40.0%. OBJECTIVE To evaluate the complex interactions between parents' vaccine-related beliefs, demographic factors, and HPV immunization status. METHODS Vaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n=8490) were analyzed. HPV vaccination status was determined from teens' health care provider (HCP) records. RESULTS Among teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (p<0.05). Among teen girls administered 1-2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration. CONCLUSION Results suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses.
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Affiliation(s)
- Philip J Smith
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, MS A-19, 1600 Clifton Road, NE, Atlanta, GA 30333, United States.
| | - Shannon Stokley
- Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
| | | | | | - Saad B Omer
- Emory University, Atlanta, GA 30322, United States.
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18
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Kempe A, O’Leary ST, Shoup JA, Stokley S, Lockhart S, Furniss A, Dickinson LM, Barnard J, Daley MF. Parental Choice of Recall Method for HPV Vaccination: A Pragmatic Trial. Pediatrics 2016; 137:e20152857. [PMID: 26921286 PMCID: PMC5884084 DOI: 10.1542/peds.2015-2857] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Completion rates for the human papillomavirus vaccine (HPV) series among adolescents remain low. Effectiveness of recall with parents choosing the method (preference-based recall) for increasing HPV series completion is unstudied. Within a cluster-randomized trial, we examined effectiveness of preference-based recall compared with usual care for increasing series completion and the association of recall choices with completion. METHODS All Kaiser Permanente Colorado pediatric practices (n = 7) were randomized to intervention (n = 4) or control (n = 3) by using covariate-constrained randomization. From January to June 2013, parents at intervention practices whose adolescents received HPV 1 were asked the recall method they preferred for subsequent doses and if they also wanted their child reminded. Completion rates were assessed 1 year after HPV 1. RESULTS At intervention practices, 374 (43%) of 867 patients were enrolled; 39% preferred text, 18% e-mail, 9% auto-dialer, and 34% 2-methods; 19% chose to have adolescent also recalled. Intervention adolescents were more likely to complete (63% vs 38%) than were controls (adjusted risk ratio 1.47 [1.38-1.57]) and less likely to be late in completing the series (45% vs 57%, P = .02). Rates of completion were similar between different recall methods, but significantly higher for those preferring e-mail and phone compared withother methods (90% vs 60%. P = .008). Completion rates were similar for adolescents who also received recalls (62%) versus those who did not (63%). CONCLUSIONS Preference-based recall was effective in increasing HPV series completion rates, with point estimates substantially higher than for most published studies of reminder/recall.
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Affiliation(s)
- Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Departments of Pediatrics, and
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Shannon Stokley
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Lockhart
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Anna Furniss
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - L. Miriam Dickinson
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Juliana Barnard
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew F. Daley
- Department of Pediatrics, University of Colorado, Aurora, Colorado,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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Rand CM, Blumkin A, Vincelli P, Katsetos V, Szilagyi PG. Parent Preferences for Communicating With Their Adolescent's Provider Using New Technologies. J Adolesc Health 2015; 57:299-304. [PMID: 26299557 DOI: 10.1016/j.jadohealth.2015.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/26/2015] [Accepted: 06/10/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Because adolescents make few health care visits, we assessed the views of parents of adolescents on various means to communicate with their adolescents' physicians about vaccine reminders and appointments, medication refills and test results-including phone, mail, e-mail, text messages, and personal health records (PHRs). METHODS We performed a cross-sectional survey of 400 parents of adolescents presenting to four pediatric offices (two urban, two suburban) in Rochester, NY in 2011 before vaccine reminders occurring in these practices. RESULTS Roughly half of parents (60% urban, 52% suburban, p = .11) were accepting of teens receiving their own vaccine reminders. Urban parents preferred communicating with the provider via telephone, whereas suburban parents preferred e-mail for most issues and a PHR for receipt of test results. In adjusted analyses, being younger was associated with preferring text message vaccine reminders (41 to <51 years: adjusted relative risk [aRR] = .8, p = .02; ≥51 years, aRR = .5, p < .001), and being a suburban parent was associated with preferring e-mail reminders (aRR = 1.6, p < .001). Those who were younger (41 to <51 years: aRR = .6, p = .007; ≥51 years: aRR = .4, p < .001) and suburban (aRR = 2.4, p < .001) were most likely to be interested in general use of a PHR. CONCLUSIONS Our study shows that some, but not all, parents are ready for electronic (text message, e-mail, PHR) communications for their adolescents' health care and that a parent age and socioeconomic divide exists. Providing options in the means in which parents communicate with an adolescent's provider is ideal.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York.
| | - Aaron Blumkin
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Phyllis Vincelli
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Viki Katsetos
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California
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20
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Smith PJ, Marcuse EK, Seward JF, Zhao Z, Orenstein WA. Children and Adolescents Unvaccinated Against Measles: Geographic Clustering, Parents' Beliefs, and Missed Opportunities. Public Health Rep 2015; 130:485-504. [PMID: 26327727 PMCID: PMC4529833 DOI: 10.1177/003335491513000512] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We evaluated the extent to which children and adolescents were not vaccinated against measles ("unvaccinated"), clustering within U.S. counties, and factors associated with unvaccination, including parents' vaccine-related beliefs and missed opportunities. METHODS We analyzed data from the 2010-2013 National Immunization Survey (NIS) and NIS-Teen Survey of households with 19- to 35-month-old children and 13- to 17-year-old adolescents, respectively. We used provider-reported vaccination histories to assess measles vaccination status. RESULTS In 2013, 7.5% of children and 4.5% of adolescents were unvaccinated against measles. Four-fifths (80.0%) of unvaccinated children lived in counties containing 41.9% of the nation's children, and 80.0% of unvaccinated adolescents lived in counties containing 30.4% of the nation's adolescents. Multivariable statistical analyses found that 74.6% of children who were unvaccinated against measles missed being vaccinated for reasons other than parents' negative vaccine-related beliefs, and 89.6% could be deemed as having at least one missed opportunity for being vaccinated against measles because they were administered at least one dose of other recommended vaccines after 12 months of age. Among adolescents, multivariable analyses found that only demographic factors, not vaccine-related parental beliefs, were independently associated with being unvaccinated. CONCLUSIONS Reasons other than negative vaccine-related beliefs, including missed opportunities, accounted for the vast majority of unvaccinated children and adolescents.
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Affiliation(s)
- Philip J. Smith
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
| | - Edgar K. Marcuse
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Jane F. Seward
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
| | - Zhen Zhao
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
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Rand CM, Brill H, Albertin C, Humiston SG, Schaffer S, Shone LP, Blumkin AK, Szilagyi PG. Effectiveness of centralized text message reminders on human papillomavirus immunization coverage for publicly insured adolescents. J Adolesc Health 2015; 56:S17-20. [PMID: 25863549 DOI: 10.1016/j.jadohealth.2014.10.273] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/13/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated a managed care organization (MCO)-generated text message reminder-recall system designed to improve human papillomavirus (HPV) vaccination coverage. METHODS We conducted a randomized controlled trial of text reminder-recall for parents of 3,812 publicly insured adolescents aged 11-16 years with no prior HPV vaccinations who were enrolled in a single MCO and were patients at one of 39 primary care practices. We determined the rate of HPV receipt for intervention versus control with the Kaplan-Meier failure function and determined hazard ratios using a clustered stratified Cox model, clustering on primary care provider and stratified on practice. We examined results for all subjects, and for those with a valid phone number, stratified by age group (11-13 years and 14-16 years) and gender. A post hoc analysis included all subjects and controlled for age and gender. RESULTS HPV dose 1 vaccination rates were not significantly different when all participants were included, but for the subset of parents (54%) able to receive messages, HPV dose 1 rates were 13% for the control group and 16% for the intervention group; hazard ratio, 1.3 (95% confidence interval, 1.0-1.6; p = .04), when controlling for age and gender. There were no significant findings in the analysis stratified by age and gender. CONCLUSIONS MCO-based text reminders are feasible and have a modest effect on HPV dose 1 vaccination rates for those parents able to receive text messages with valid phone numbers in the MCO database. Future studies should examine a similar intervention for those parents who already accepted the first HPV vaccine dose.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Howard Brill
- Monroe Plan for Medical Care, Rochester, New York
| | - Christina Albertin
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sharon G Humiston
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Stanley Schaffer
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Laura P Shone
- Department of Research, Division of Primary Care Research, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Aaron K Blumkin
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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