Does intention to recommend HPV vaccines impact HPV vaccination rates?

Abstract

Despite recommendations for routine vaccination, HPV vaccination rates among adolescent females have remained low. The objective of this prospective cohort study was to determine whether clinician intention to recommend HPV vaccines predicts HPV vaccine series initiation among previously unvaccinated 11 to 18 year-old girls (N=18,083) who were seen by a pediatric clinician (N=105) from a large primary care network within 3 years of vaccine introduction. We used multivariable logistic regression with generalized estimating equations, Cox Regression and standardized survival curves to measure the association between clinician intention and time to and rate of first HPV vaccine receipt among eligible females. All models adjusted for patient age, race/ethnicity, payor category, visit type, and practice location. Eighty-5 percent of eligible 11 to 12 year-old and 95% of 13 to 18 year-old girls were seen by a provider reporting high intention to recommend HPV vaccines. However, only 30% of the cohort initiated the HPV vaccine series and the mean number of days from first eligible visit to series initiation was 190 (95% C.I. 184.2, 195.4). After adjusting for covariates, high clinician intention was modestly associated with girls' likelihood of HPV vaccine series initiation (OR 1.36; 95 % C.I. 1.07, 1.71) and time to first HPV vaccination (HR 1.22; 95% 1.06, 1.40). Despite high intention to vaccinate among this cohort of pediatric clinicians, overall vaccination rates for adolescent girls remained low. These findings support ongoing efforts to develop effective strategies to translate clinician intention into timely HPV vaccine receipt.

Japanese physicians’ attitudes and intentions regarding human papillomavirus vaccine compared with other adolescent vaccines

“…In this survey, 26% of physicians reported concerns about the safety of HPVV, significantly higher than concerns reported about the other NIP adolescent vaccines. Although these may not be the only factors contributing to low HPVV rates in Japan, physician recommendation is recognized as one of the most powerful predictors of HPVV acceptance [21]. Several studies have reported that provider-focused interventions, including provision of information about adolescent vaccines, have the potential to improve immunization coverage [7,8,[32], [33], [34], [35], [36]].…”

“…Even in the United States (US), a country with a strong immunization program and recommendations, several studies report barriers that make increasing adolescent immunization coverage difficult including safety concerns, lack of knowledge about HPVV, no provider recommendation, personal beliefs, lack of access to healthcare services and competing priorities in an adolescent's schedule (e.g., extra-curricular activities, low priority for seeking medical care) [[9], [10], [11], [12], [13]]. Provider-related barriers have also been reported in the US, such as lack of knowledge about HPVV, negative attitudes toward adolescent immunizations, inconsistent strength of recommendation, and missed opportunities [[14], [15], [16], [17], [18], [19], [20], [21]].…”

“…Several studies have reported that physician recommendations increase adolescent vaccine acceptance [9,11,[14], [15], [16]], particularly in the case of HPVV [[17], [18], [19], [20], [21]]. Most vaccines for adolescents are delivered by physicians in public and private clinics in Japan.…”

US Health Care Clinicians' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Vaccination: A Qualitative Systematic Review

“…In studies that examined intention among clinicians, rates varied widely, from 16% to 96%. 17,[19][20][21][22][23]33,37,41,44,57,69,71 The mean for intention rates was 66.9 (SD ¼ 23) and the median was 73; the 16% intention rate was an outlier. In 2 studies that examined intention according to patient age, intention was higher for 13-to 18-year-olds (92%-96%) than 11-to 12-yearolds (73%-78%).…”

Wie werden die Impfempfehlungen gegen saisonale Influenza und gegen humane Papillomaviren in gynäkologischen Praxen umgesetzt?

“…Die Differenz zwischen der positiven Einstellung gefragter Ärztinnen und Ärzte und den erreichten Impfquoten zeigte sich auch in Befragungen in den USA [32]. Weitere internationale Studien schlussfolgern, dass insbesondere bei der HPV-Impfung zusätzliche Faktoren berücksichtigt werden müssen, die den Zusammenhang zwischen der Impfempfehlung durch den Arzt und der finalen Impfentscheidung beeinflussen: Insbesondere die von den Eltern wahrgenommenen Sicherheitsbedenken der Impfung und die Annahme, die Impfung sei nicht notwendig, spielen eine wichtige Rolle [33,34].…”