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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. Source

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. Source

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. Source

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