1. Online training for pediatricians on human papillomavirus (HPV) communication strategies is associated with an increase in rates of HPV vaccination, reducing missed opportunities for HPV vaccination
Evidence Rating Level: 1 (Excellent)
Study Rundown: Human papillomavirus (HPV) is one of the most prevalent infectious causes of cancer, linked to more than 33 700 new cases of cervical, oropharyngeal, anal, vulvar, vaginal, and penile cancers each year in the U.S. alone. Prior observational studies have shown that a higher HPV vaccination rate is linked to effective communications from pediatric clinicians through strategies such as normalization of HPV vaccines like other adolescent immunizations. In this cluster-randomized clinical trial, pediatric primary care practices across the U.S. were recruited to undergo investigation of the effect of asynchronous online modules educating pediatric clinicians on communication strategies for HPV with the goal of enhancing HPV vaccination rates in adolescents. Amongst the 48 randomized clinical practices, missed HPV vaccination opportunity (defined as a visit during which HPV vaccine was due but not administered), dropped by 2.4 percentage points in the intervention group (education on HPV communication strategies) when compared to the control group at subsequent well-child check visits. Additionally, the HPV vaccine initiation rate for eligible adolescents in the intervention group was higher by 3.4 percentage points when compared to the control group. One strength of this study is the large number of practices that participated in the clustered randomized clinical trial, which significantly increased the statistical power of the study. The intervention was scalable with weekly reinforcement; the study was conducted in a methodologically rigorous manner. However, the study has limitations as well, primarily a potential selection bias intrinsic to the study since pediatric practices sign up to have opted into the study.
Click to read the study in JAMA Pediatrics
Relevant Reading: Annual Report to the Nation on the Status of Cancer, 1975–2009, Featuring the Burden and Trends in Human Papillomavirus (HPV)–Associated Cancers and HPV Vaccination Coverage Levels
In-Depth [Randomized clinical trial]: In this randomized clinical trial of 48 pediatric clinical practices with 73277 office visits, the intervention group exhibited a greater reduction in missed opportunities for HPV initiation than the control group by 6.8 percentage points (−6.8%; −9.7%to −3.9% [95% Confidence Interval]))) at the well-child check visits. Adjustment for age, sex, and interactions did not significantly alter the clinical findings. Similarly, the intervention resulted in a 3.4 percentage point increase in HPV vaccine initiation compared to control (0.6%-6.2% [95% Confidence Interval])
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