Practice Facilitation to Support Primary Care Physicians With COVID-19 Vaccine Uptake
Notice bibliographique
Résumé
Importance: Recommendations by family physicians are associated with uptake of vaccines, but many family physicians had limited capacity to identify patients in their practice who might benefit from personalized vaccination counselling. Practice facilitation is an evidence-based method of supporting changes in primary care, but its role in supporting COVID-19 vaccination rates is unknown. Objective: To determine whether a multicomponent practice facilitation intervention would increase COVID-19 vaccine rates in the practices of family physicians with the largest number of unvaccinated patients. Design, Setting, and Participants: This 2-arm cluster-randomized clinical trial was conducted from November 15, 2021, to March 15, 2022, in Ontario, Canada's most populous province. Data were obtained from the provincial vaccine registry and were linked to routinely used administrative databases. Six hundred family physicians whose practices had the largest number of unvaccinated rostered patients in the province were randomized 1:1 to a practice facilitation intervention or a control group. Eighteen were excluded because they were not practicing family physicians. Follow-up was completed March 31, 2022, and data were analyzed from March 2023 to May 2024. The primary analysis was by intention-to-treat; unit of analysis was the patient. Intervention: Practice facilitators offered physicians support to identify, reach out to, and counsel their unvaccinated patients. Main Outcomes and Measures: Any vaccine dose during a 4-month follow-up interval among rostered patients older than 12 years was used to calculate the rate of doses per 100 patients. A modified robust Poisson regression method was used to analyze intervention effects; intervention effect was estimated as relative risk (RR) using least square means differences with 95% CIs. Results: Of 582 physicians included in the analysis (median age, 58 [IQR, 52-66] years; 426 [73.2%] male), 292 were randomized to the control arm and 290 to the intervention arm. Only 84 physicians (29.0%) in the intervention arm accepted assistance from a practice facilitator. Mean numbers of doses of COVID-19 vaccines per 100 patients were 49.8 (95% CI, 48.8-50.9) in the intervention arm and 50.2 (95% CI, 49.2-51.2) in the control arm (adjusted RR, 0.99; 95% CI, 0.96-1.02). Conclusions and Relevance: In this study, practice facilitation to primary care clinics with high numbers of patients unvaccinated against COVID-19 was not associated with significant changes in vaccination uptake. Findings suggest the importance of ensuring that interventions target health services with high levels of both motivation and opportunity for improvement. Trial Registration: ClinicalTrials.gov Identifier: NCT05099497.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».