Effect of provider recommendation style on the length of adolescent vaccine discussions

Anny T H R Fenton; Chelsea Orefice; Terresa J Eun; Dea Biancarelli; Amresh Hanchate; Mari-Lynn Drainoni; Rebecca B Perkins

doi:10.1016/j.vaccine.2020.11.015

Effect of provider recommendation style on the length of adolescent vaccine discussions

Vaccine. 2021 Feb 5;39(6):1018-1023. doi: 10.1016/j.vaccine.2020.11.015. Epub 2021 Jan 12.

Authors

Anny T H R Fenton¹, Chelsea Orefice², Terresa J Eun³, Dea Biancarelli⁴, Amresh Hanchate⁵, Mari-Lynn Drainoni⁶, Rebecca B Perkins⁷

Affiliations

¹ Maine Medical Center Research Institute, Portland, ME, USA. Electronic address: annyt_fenton@dfci.harvard.edu.
² Springfield Department of Health and Human Services, Springfield MA, USA.
³ Stanford University, Stanford, CA, USA. Electronic address: tjeun@stanford.edu.
⁴ Accenture, Boston, MA, USA.
⁵ Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: ahanchat@wakehealth.edu.
⁶ Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Implementation and Improvement Sciences, Boston University, Boston, MA, USA. Electronic address: drainoni@bu.edu.
⁷ Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA. Electronic address: rbperkin@bu.edu.

Abstract

Objective: To determine whether providers' vaccine recommendation style affects length of the adolescent vaccine discussions.

Methods: We analyzed vaccine discussions using audio-recordings of clinical encounters where adolescents were eligible for HPV vaccines ± meningococcal vaccines. We measured length of vaccine discussions, the provider's use of an "indicated" (vaccination due at visit) or "elective" (vaccination is optional) recommendation style, and vaccine receipt. Parent and child demographics, parental vaccination intentions, and parental satisfaction with vaccine discussion were collected from pre- and post-visit surveys. We used linear and logit regressions with random effects to estimate recommendation style's association with discussion length and with vaccine receipt, respectively.

Results: We analyzed 106 vaccine discussions (82 HPV; 24 meningococcal) across 82 clinical encounters and 43 providers. Vaccine discussions were longer when providers presented vaccination as elective versus indicated (140 vs. 74 s; p-value < 0.001). Controlling for vaccine type, parental vaccination intent, and patient characteristics, an elective style was associated with 41 seconds longer vaccine discussion (p-value < 0.05). Providers used the indicated style more frequently with the meningococcal vaccine than with the HPV vaccine (96% vs. 72%; p-value < 0.05). Parents' odds of vaccinating were 9.3 times higher following an indicated versus an elective presentation (p-value < 0.05). Vaccine discussion length and presentation style were not associated with parental satisfaction.

Conclusions: Our results suggest that using an indicated recommendation improves vaccine discussions' efficiency and effectiveness, but this style is used more often with meningococcal than HPV vaccines. Increasing providers' use of indicated styles for HPV vaccines has the potential to increase vaccination rates and save time during medical visits.

Keywords: Patient satisfaction; Vaccine communication; Visit duration.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Health Knowledge, Attitudes, Practice
Humans
Meningococcal Vaccines*
Papillomavirus Infections* / prevention & control
Papillomavirus Vaccines*
Parents
Vaccination

Substances

Meningococcal Vaccines
Papillomavirus Vaccines

Grants and funding

T32 HL151323/HL/NHLBI NIH HHS/United States