Browsing by Author "Kulkarni, Amit"

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    Health care providers’ perceptions of use and influence of clinical decision support reminders: qualitative study following a randomized trial to improve HPV vaccination rates
    (BMC, 2017-08-10) Dixon, Brian E.; Kasting, Monica L.; Wilson, Shannon; Kulkarni, Amit; Zimet, Gregory D.; Downs, Stephen M.; Epidemiology, School of Public Health
    Background Human Papillomavirus (HPV) leads to serious health issues and remains the most common sexually transmitted infection. Despite availability of effective vaccines, HPV vaccination rates are suboptimal. Furthermore, providers recommend the HPV vaccine less than half the time for eligible patients. Prior informatics research has demonstrated the effectiveness of computer-based clinical decision support (CDS) in changing provider behavior, especially in the area of preventative services. Methods Following a randomized clinical trial to test the effect of a CDS intervention on HPV vaccination rates, we conducted semi-structured interviews with health care providers to understand whether they noticed the CDS reminders and why providers did or did not respond to the prompts. Eighteen providers, a mix of medical doctors and nurse practitioners, were interviewed from five publicly-funded, urban health clinics. Interview data were qualitatively analyzed by two independent researchers using inductive content analysis. Results While most providers recalled seeing the CDS reminders, few of them perceived the intervention as effective in changing their behavior. Providers stated many reasons for why they did not perceive a change in their behavior, yet the results of the trial showed HPV vaccination rates increased as a result of the intervention. Conclusions CDS reminders may be effective at changing provider behavior even if providers perceive them to be of little use. Trial registration ClinicalTrials.gov Identifier: NCT02551887 , Registered on September 15, 2015 Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0521-6) contains supplementary material, which is available to authorized users.
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    Healthcare providers’ beliefs and attitudes regarding risk compensation following HPV vaccination
    (Elsevier, 2016-05-28) Kasting, Monica L.; Wilson, Shannon; Dixon, Brian E.; Downs, Stephen M.; Kulkarni, Amit; Zimet, Gregory D.; Epidemiology, School of Public Health
    Background Provider recommendation is a significant predictor of HPV vaccine uptake. Prior research suggests that concerns regarding risk compensation could cause some providers to hesitate recommending the HPV vaccine. Methods During 15–30 min semi-structured interviews in early 2015, 22 U.S. pediatric providers were asked about their beliefs regarding sexual risk compensation and cervical cancer screening following HPV vaccination. Providers were asked if these beliefs result in reservations recommending the vaccine. Interviews were audio-recorded, transcribed, and analyzed using inductive content analysis. Results None of the providers believed the HPV vaccine would result in risky sexual behavior. Half indicated it was better to start vaccination early, before sexual activity was a worry. Others noted that patients’ risky behavior decisions happen independently of vaccination. When providers were asked if they were concerned about decreased cervical cancer screening, half said they did not know and some stated they had never thought about it before. The main themes addressed were the significant time lapse between vaccination and screening and that women tend to get over-screened as opposed to under-screened. Conclusion Providers were generally in favor of HPV vaccination and do not perceive risk compensation as a barrier to HPV recommendation.
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    Pediatrician-Parent Conversations about Human Papillomavirus Vaccination: An Analysis of Audio-Recordings
    (Elsevier, 2017-08) Sturm, Lynne; Donahue, Kelly; Kasting, Monica; Kulkarni, Amit; Brewer, Noel T.; Zimet, Gregory D.; Pediatrics, School of Medicine
    Purpose We sought to establish which human papillomavirus (HPV) vaccine communication approaches by pediatricians were associated with same-day HPV vaccination of 11- to 12-year-olds by evaluating audio recordings of visits. Methods Verilogue, a market research company maintaining a panel of primary care pediatricians, provided audio recordings and transcriptions of well-child visits for 11- to 12-year-old patients from January through June 2013. Seventy-five transcripts from 19 pediatricians were coded for use of presumptive language (i.e., words conveying assumption of vaccine delivery), offer of delay, recommendation strength, and information provision. Using logistic regression, we evaluated the association between pediatrician communication approaches and agreement to same-day HPV vaccination. Generalized estimating equations accounted for clustering of patients within pediatricians. Results Same-day agreement to HPV vaccination occurred in 29% of encounters. Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine (73% vs. 22%; odds ratio = 8.96; 95% confidence interval = 2.32–34.70). Pediatricians offered or recommended delay in most encounters (65%). HPV vaccine acceptance occurred far more often when pediatricians did not mention delaying vaccination (82% vs. 6%; odds ratio = 80.84; 95% confidence interval = 15.72–415.67). Same-day vaccination was not associated with strength of recommendation or pediatrician reference to vaccinating their own children. Conclusions Our findings highlight the need to develop and evaluate physician-focused trainings on using presumptive language for same-day HPV vaccination.
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    A qualitative study of healthcare provider awareness and informational needs regarding the nine-valent HPV vaccine
    (Elsevier, 2016-03) Kasting, Monica L.; Wilson, Shannon; Dixon, Brian E.; Downs, Stephen M.; Kulkarni, Amit; Zimet, Gregory D.; Department of Epidemiology, Richard M. Fairbanks School of Public Health
    The 9-valent Human Papillomavirus (HPV) vaccine, 9vHPV, was licensed in the U.S. in December, 2014. We assessed healthcare provider (HCP) awareness of the newly approved vaccine and identified questions HCPs have about the vaccine. As part of a larger study, we used semi-structured interviews to ask 22 pediatric HCPs about their awareness of 9vHPV, questions they have about the vaccine, and questions they anticipate from patients and parents. Interviews were audio-recorded and transcribed then analyzed using inductive content analysis. Over half were aware of the vaccine but few HCPs claimed to be familiar with it. HCPs indicated several questions with common themes pertaining to efficacy, side effects, and cost. Only half of HCPs believed patients or parents would have questions. The results suggest strategies and areas for health systems and public health organizations to target in order to resolve unmet educational needs among HCPs regarding 9vHPV.
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    Simple and Elaborated Clinician Reminder Prompts for Human Papillomavirus Vaccination: A Randomized Clinical Trial
    (Elsevier, 2018-03) Zimet, Gregory D.; Dixon, Brian E.; Xiao, Shan; Tu, Wanzhu; Kulkarni, Amit; Dugan, Tamara; Sheley, Meena; Downs, Stephen M.; Pediatrics, School of Medicine
    Objective To evaluate the effects of simple and elaborated health care provider (HCP) reminder prompts on human papillomavirus (HPV) vaccine initiation rates. Methods Twenty-nine pediatric HCPs serving 5 pediatric clinics were randomized to 1 of 3 arms: 1) usual practice control, 2) simple reminder prompt, and 3) elaborated reminder prompt, which included suggested language for recommending the early adolescent platform vaccines. Prompts were delivered via a computer-based clinical decision support system deployed in the 5 clinics. Eligible patients were ages 11 to 13 years, had not received HPV vaccine, and were due for meningococcal ACWY (MenACWY) vaccine and/or the tetanus, diphtheria, and pertussis booster (Tdap). Receipt of HPV vaccine was determined via automated queries sent to the Indiana immunization registry. Data were analyzed via logistic regression models, with generalized estimating equations used to account for the clustering of patients within HCPs. Results Ten HCPs in the control group saw 301 patients, 8 HCPs in the simple prompt group saw 124, and 11 HCPs in the elaborated prompt group saw 223. The elaborated prompt arm had a higher rate of HPV vaccination (62%) than the control arm (45%): adjusted odds ratio, 2.76; 95% confidence interval, 1.07 to 7.14. The simple prompt arm did not differ significantly from the control arm with respect to HPV vaccine initiation, which might have been because of the small sample size for this arm. MenACWY and Tdap rates did not vary across the 3 arms. Conclusions Results suggest that an elaborated HCP-targeted reminder prompt, with suggested recommendation language, might improve rates of HPV vaccine initiation.