Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus Vaccination Rates: A Cluster Randomized Clinical Trial

摘要: Importance Missed opportunities for human papillomavirus (HPV) vaccination during pediatric health care visits are common. Objectives To evaluate the effect of online communication training clinicians on missed HPV rates overall and at well-child (WCC) acute or chronic illness (hereafter referred to as visits) adolescent rates. Design, Setting, Participants From December 26, 2018, July 30, 2019, a longitudinal cluster randomized clinical trial allocated practices vs standard in staggered 6-month periods. A total 48 primary 19 states were recruited from American Academy Pediatrics Pediatric Research Office Settings network. intervention practices. Outcomes evaluated all 11- 17-year-old adolescents attending 24 (188 clinicians) control (177 clinicians). Analyses performed an intent-to-treat basis, accounting clustering by practice. Interventions Three sequential educational modules developed help participating communicate with parents about vaccine. Weekly text messages sent reinforce learning. Statisticians blinded group assignment. Main Measures outcomes vaccine initiation subsequent doses WCC (visit-level outcome). Secondary (person-level compared baseline. Results Altogether, 122 188 participated; these, 120, 119, 116 completed 1, 2, 3, respectively. During period, 29 206 (14 664 girls [50.2%]; mean [SD] age, 14.2 [2.0] years) made 15 888 28 123 practices; 33 914 (17 069 [50.3%]; 17 910 35 281 Intervention reduced 2.4 percentage points (−2.4%; 95% CI, −3.5% −1.2%) more than controls. 6.8 (−6.8%; −9.7% −3.9%) The had no visits. Adolescents 3.4-percentage point (95% 0.6%-6.2%) greater improvement Conclusions Relevance This scalable, increased vaccination, particularly support dissemination this intervention. Trial Registration ClinicalTrials.gov Identifier:NCT03599557