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Effectiveness of a multimodal intervention to increase vaccination in obstetrics/gynecology settings
Institution:1. Adult and Child Consortium for Outcomes Research and Delivery Science Program (ACCORDS), Children’s Hospital Colorado, University of Colorado Denver, USA;2. Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA;3. Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA;1. Kirby Institute, University of New South Wales, Kensington, NSW, Australia;2. National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW, Australia;3. Kids Research Institute, The Children’s Hospital Westmead, Westmead, NSW, Australia;4. Vaccinology and Immunology Research Trials Unit, Women’s and Children’s Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia;5. National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia;6. Department of Health, South Australia, Adelaide, SA, Australia;1. Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;2. Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan;3. Yoiko-no Shounika Sato, Niigata, Japan;4. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;5. Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan;1. The Child Health Evaluation and Research (CHEAR) Center, Division of General Pediatrics, University of Michigan, 300 N Ingalls St, Ann Arbor, MI 48109, United States;2. Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS) Program, University of Colorado, Anschutz Medical Campus, UPI Building, Mailstop F-443, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States;1. School of Nursing, University of South Florida, Tampa, Florida;2. National Healthy Mothers, Healthy Babies Coalition, Alexandria, Virginia;3. Consultant, Decatur, Georgia;4. Voxiva, Inc., Washington, District of Columbia;5. Biostatistics Center, Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland;6. Johns Hopkins Global mHealth Initiative, Johns Hopkins University, Baltimore, Maryland;1. Emory University, Department of Epidemiology and Laney Graduate School, Atlanta, GA, United States;2. Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, and Division of Infectious Diseases, Department of Medicine, Atlanta, GA, United States;3. Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States;4. Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, United States;5. Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, United States;6. University of Kansas Medical Center, Department of Obstetrics and Gynecology, Kansas City, KS, United States;7. Emory University, Emory Vaccine Center and School of Medicine, Atlanta, GA, United States;8. Emory University, Department of Pediatrics, Atlanta, GA, United States;1. Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;2. Center for Health Literacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
Abstract:ObjectiveTo test the effectiveness of a multimodal intervention in obstetrics/gynecology (ob-gyn) clinics to increase uptake of influenza and tetanus-diphtheria-acellular pertussis (Tdap) vaccines in pregnant women and these vaccines plus human papillomavirus (HPV) vaccine in non-pregnant women.MethodsA cluster randomized controlled trial among 9 private ob-gyn practices in Colorado from 9/2011 to 5/2014. The intervention consisted of: designation of immunization champions, staff/provider trainings, assistance with vaccine purchasing/management, identification of eligible patients, standing order implementation, chart review/feedback, and patient education materials. Control practices continued usual care. Primary outcomes were receipt of influenza and Tdap vaccines among pregnant women and these vaccines plus HPV vaccine among non-pregnant women, comparing a Baseline period (Year 0/Year 1) to Year 2, intervention versus control. With an estimated sample size of 32,590 per arm, there would be >80% power to detect a 10% difference between groups.ResultsIn the Baseline period, 27% of pregnant women in both intervention and control practices received influenza vaccine. In Year 2, 29% of pregnant women in intervention practices received influenza vaccine versus 41% in control practices. In the Baseline period, 18% of pregnant women in intervention practices received Tdap vaccine versus 22% in control practices. Both intervention and control practices increased to 51% in Year 2, representing an increase of 33% for intervention practices and 29% for control practices, consistent with a change in Tdap recommendations. Relatively few HPV, influenza or Tdap vaccines (≤6% of eligible patients) were given to non-pregnant patients in either intervention or control practices at any time during the study.ConclusionIn this cluster randomized trial designed to increase vaccination uptake, both intervention and control practices showed improved vaccination of pregnant but not non-pregnant patients. Future work should focus on tailoring evidence-based immunization practices or developing new approaches to specifically fit busy ob-gyn offices.
Keywords:Vaccine  Attitudes  Health communication  Influenza immunization  Tdap  HPV vaccine  Maternal immunization  Ob-gyn physicians  Patient-provider communication  Pregnant Women  Gynecological patients  ACIP"}  {"#name":"keyword"  "$":{"id":"k0065"}  "$$":[{"#name":"text"  "_":"Advisory Committee on Immunization Practices  VFC"}  {"#name":"keyword"  "$":{"id":"k0075"}  "$$":[{"#name":"text"  "_":"Vaccines for Children  ACA"}  {"#name":"keyword"  "$":{"id":"k0085"}  "$$":[{"#name":"text"  "_":"Affordable Care Act  ACOG"}  {"#name":"keyword"  "$":{"id":"k0095"}  "$$":[{"#name":"text"  "_":"American College of Obstetricians and Gynecologists  Ob-gyn"}  {"#name":"keyword"  "$":{"id":"k0105"}  "$$":[{"#name":"text"  "_":"obstetrician-gynecologist  CDC"}  {"#name":"keyword"  "$":{"id":"k0115"}  "$$":[{"#name":"text"  "_":"Centers for Disease Control and Prevention  Tdap"}  {"#name":"keyword"  "$":{"id":"k0125"}  "$$":[{"#name":"text"  "_":"tetanus diphtheria and acellular pertussis vaccine  HPV"}  {"#name":"keyword"  "$":{"id":"k0135"}  "$$":[{"#name":"text"  "_":"human papillomavirus
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