Carolina Beach, NC, United States
Carolina Beach, NC, United States

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PubMed | North Carolina Immunization Branch, University of North Carolina at Chapel Hill and Harvard University
Type: Journal Article | Journal: Pediatrics | Year: 2016

Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive announcements or participatory conversations.In 2015, we conducted a parallel-group randomized clinical trial with 30 pediatric and family medicine clinics in central North Carolina. We randomized clinics to receive no training (control), announcement training, or conversation training. Announcements are brief statements that assume parents are ready to vaccinate, whereas conversations engage parents in open-ended discussions. A physician led the 1-hour, in-clinic training. The North Carolina Immunization Registry provided data on the primary trial outcome: 6-month coverage change in HPV vaccine initiation (1 dose) for adolescents aged 11 or 12 years.The immunization registry attributed 17173 adolescents aged 11 or 12 to the 29 clinics still open at 6-months posttraining. Six-month increases in HPV vaccination coverage were larger for patients in clinics that received announcement training versus those in control clinics (5.4% difference, 95% confidence interval: 1.1%-9.7%). Stratified analyses showed increases for both girls (4.6% difference) and boys (6.2% difference). Patients in clinics receiving conversation training did not differ from those in control clinics with respect to changes in HPV vaccination coverage. Neither training was effective for changing coverage for other vaccination outcomes or for adolescents aged 13 through 17 (n = 37796).Training providers to use announcements resulted in a clinically meaningful increase in HPV vaccine initiation among young adolescents.


Moss J.L.,University of North Carolina at Chapel Hill | Reiter P.L.,Ohio State University | Dayton A.,North Carolina Immunization Branch | Brewer N.T.,University of North Carolina at Chapel Hill
Vaccine | Year: 2012

Objective: To evaluate a brief intervention to increase provision of adolescent vaccines at health centers that reach the medically underserved. Method: In April 2010, clinical coordinators from 17 federally qualified health centers (serving 7827 patients ages 12-17) participated in a competition to increase uptake of recommended adolescent vaccines: tetanus, diphtheria, and pertussis booster; meningococcal conjugate; and human papillomavirus. Vaccination coordinators attended a webinar that reviewed provider-based changes recommended by the CDC's Assessment, Feedback, Incentives, and eXchanges (AFIX) program and received weekly follow-up emails. Data on vaccine uptake came from the North Carolina Immunization Registry. Results: Uptake of targeted adolescent vaccines increased during the one-month intervention period by about 1-2% (all . p<. .05). These small but reliable increases were greater than those observed for non-targeted vaccines (measles, mumps, and rubella; hepatitis B; and varicella). Conclusion: This AFIX webinar led to small increases in provision of targeted adolescent vaccines over a one-month period. Similar, sustainable programs at healthcare facilities, including federally qualified health centers that function as safety net providers for medically underserved populations could help reach populations with great need. © 2012 Elsevier Ltd.


Moss J.L.,University of North Carolina at Chapel Hill | Gilkey M.B.,University of North Carolina at Chapel Hill | Griffith T.,University of North Carolina at Chapel Hill | Bowling J.M.,University of North Carolina at Chapel Hill | And 4 more authors.
Vaccine | Year: 2013

Objective: To analyze organizational correlates of immunization coverage among adolescents served by high-volume primary care providers in North Carolina. Methods: We randomly selected 91 clinics with at least 200 active records for patients ages 11-18 in the North Carolina Immunization Registry. For the 105,121 adolescents served by these clinics, we obtained immunization status for 6 vaccines, including human papillomavirus (HPV) vaccine (females only); meningococcal conjugate; and tetanus, diphtheria, and pertussis booster (Tdap). Results: Clinics specializing in pediatrics had higher coverage for meningococcal vaccine (OR. = 1.79, 95% CI: 1.25-2.55), Tdap vaccine (OR. = 1.22, 95% CI: 1.00-1.50), and childhood vaccines. However, pediatric clinics had lower coverage for HPV vaccine initiation (OR. = 0.70, 95% CI: 0.52-0.94). Other correlates, which varied by vaccine, included policies related to vaccine documentation and the age at which clinics recommended vaccines. Conclusion: Overall, adolescents were more likely to receive vaccines, except HPV vaccine, if they attended a pediatric clinic with supportive clinical policies. © 2013 Elsevier Ltd.


Chung R.J.,Duke University | Walter E.B.,Duke University | Kemper A.R.,Duke University | Dayton A.,North Carolina Immunization Branch
Journal of Adolescent Health | Year: 2015

Purpose To improve adolescent immunization coverage in a rural North Carolina county. Methods Adolescent immunization coverage rates in an intervention and four comparison counties were compared over 1 year. We introduced practice-based interventions in seven practices centering on immunization registry-driven recall of adolescents for immunizations with postcard reminders (Phase 1), and 6 months later employed nontargeted school-generated telephone reminders to parents of adolescents (Phase 2). Results Improvements in the intervention county among 11-to 12-year-olds occurred for first-dose human papillomavirus vaccine in both boys (overall change, 14.2%-32.1%) and girls (27.4%-43.4%) and the meningococcal vaccine (34.6%-49.4%). Improvements among adolescents 13-18 years were limited to human papillomavirus vaccine completion in boys (1.6%-4.2%). Improvements were greater during Phase 1 than Phase 2 and among younger adolescents. Coverage improvements in the comparison counties were smaller than those observed in the intervention county. Conclusions A resource-light two-phase intervention led to modest improvements in immunization coverage, most notably in the largest adolescent practice in the county, and suggested potential for further gains, particularly among younger adolescents. © 2015 Society for Adolescent Health and Medicine.


PubMed | North Carolina Immunization Branch and Duke University
Type: Journal Article | Journal: The Journal of adolescent health : official publication of the Society for Adolescent Medicine | Year: 2015

To improve adolescent immunization coverage in a rural North Carolina county.Adolescent immunization coverage rates in an intervention and four comparison counties were compared over 1 year. We introduced practice-based interventions in seven practices centering on immunization registry-driven recall of adolescents for immunizations with postcard reminders (Phase 1), and 6 months later employed nontargeted school-generated telephone reminders to parents of adolescents (Phase 2).Improvements in the intervention county among 11- to 12-year-olds occurred for first-dose human papillomavirus vaccine in both boys (overall change, 14.2%-32.1%) and girls (27.4%-43.4%) and the meningococcal vaccine (34.6%-49.4%). Improvements among adolescents 13-18 years were limited to human papillomavirus vaccine completion in boys (1.6%-4.2%). Improvements were greater during Phase 1 than Phase 2 and among younger adolescents. Coverage improvements in the comparison counties were smaller than those observed in the intervention county.A resource-light two-phase intervention led to modest improvements in immunization coverage, most notably in the largest adolescent practice in the county, and suggested potential for further gains, particularly among younger adolescents.

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