title: Increasing provision of adolescent vaccines in primary care: a randomized controlled trial.
abstract: OBJECTIVE
  To assess the effectiveness of in-person and webinar-delivered AFIX (Assessment, Feedback, Incentives, and eXchange) consultations for increasing adolescent vaccine coverage.
  
  
  METHODS
  We randomly assigned 91 primary care clinics in North Carolina, serving 107 443 adolescents, to receive no consultation or an in-person or webinar AFIX consultation. We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011. The state's immunization registry provided vaccine coverage data for younger patients (ages 11-12 years) and older patients (ages 13-18 years) for 3 adolescent vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); meningococcal; and human papillomavirus (HPV) vaccines (≥1 dose, females only).
  
  
  RESULTS
  At the 5-month follow-up, AFIX consultations increased vaccine coverage among younger adolescents. Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap (3.4% [95% confidence interval (CI): 2.2 to 4.6]), meningococcal (4.7% [95% CI: 2.3 to 7.2], and HPV (1.5% [95% CI: 0.3 to 2.7]) vaccines. Patients in the webinar versus control arm also experienced larger changes for these vaccines. AFIX did little to improve coverage among older adolescents. At 1 year, the 3 arms showed similar coverage changes. The effectiveness of in-person and webinar consultations was not statistically different at either time point (all, P >.05).
  
  
  CONCLUSIONS
  Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents. AFIX consultations for adolescents need improvement to have a stronger and more durable impact, especially for HPV vaccine.
authors.affiliation: Lineberger Comprehensive Cancer Center, and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; and.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.affiliation: North Carolina Division of Public Health, Raleigh, North Carolina.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Dayton
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; and.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moss
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; and.
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Sparks
authors.affiliation: North Carolina Division of Public Health, Raleigh, North Carolina.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Grimshaw
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; and.
authors.forename: James M
authors.initials: JM
authors.lastname: Bowling
authors.affiliation: Lineberger Comprehensive Cancer Center, and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; and ntb@unc.edu.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards / Q000706:statistics & numerical data*; D002648:Child; D004168:Diphtheria Toxoid; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D010567:Pertussis Vaccine; D011320:Primary Health Care / Q000592:standards; D012017:Referral and Consultation; D013745:Tetanus Toxoid; D014611:Vaccination / Q000706:statistics & numerical data*; D022282:Vaccines, Acellular
chemical_list: D004168:Diphtheria Toxoid; D010567:Pertussis Vaccine; D013745:Tetanus Toxoid; D022282:Vaccines, Acellular
keywords: North Carolina; adolescent health services; human papillomavirus infections/prevention and control; vaccination/statistics and numerical data