Evaluation of Human Papillomavirus Vaccination After Pharmacist-Led Intervention: A Pilot Project in an Ambulatory Clinic at a Large Academic Urban Medical Center

Abstract

Objectives Despite the safety and efficacy of the human papillomavirus (HPV) vaccine, many persons are still not receiving it. The purpose of this pilot project was to evaluate the number of first doses of the 9-valent HPV (9vHPV) vaccination administered after a pharmacist-led intervention in the Adult Family Planning Clinic at Grady Health System (GHS), a large academic urban medical center in Atlanta, Georgia. Methods The pilot project had 3 phases: pre-intervention (November 15, 2016, through March 31, 2017), active intervention (November 15, 2017, through December 29, 2017), and post-intervention (December 30, 2017, through March 31, 2018). The pre-intervention phase was used as a historical control. The active intervention phase consisted of pharmacist interventions in the clinic and patient and health care provider education. The post-intervention phase evaluated the durability of pharmacist-led interventions performed and education provided during the active phase. Results Eighty-nine first-dose 9vHPV vaccines (of the 3-dose series) were administered to young adults aged 18-26 during the project period (November 15, 2017, through March 31, 2018); none were administered during the pre-intervention phase. Of 89 patients who received a first 9vHPV vaccine dose, 20 patients also received a second 9vHPV vaccine dose. During the project period, 166 doses of 9vHPV vaccine (first, second, or third doses) were administered. Conclusion This pharmacist-led intervention led to an increase in the number of young adult patients receiving their first dose of the 9vHPV vaccination series. With the support of other health care providers, pharmacist-led initiatives can expand vaccine-related health literacy and facilitate access to immunization services.

The interface between U.S. primary care clinics and pharmacies for HPV vaccination delivery: A scoping literature review

“… Pilot strategies varied according to state. Merk Sharm & Dohme NCI Agency for Healthcare Research & Quality American Cancer Society Cebollero J, et al ( Cebollero et al, 2020 ) (2020) Repeated measures pre-post Three phases: 1) captured baseline data, 2) active pharmacist led intervention in clinic with patient and healthcare provider education, added a prompt to EMR and clinic staff administered vaccines; 3) evaluated the durability of interventions. Single Southeast Urban adult family planning clinic Number of patients aged 18–26 who visited clinic and the number of 9vHPV vaccines administered in the clinic in the pre and posttest time periods.…”

“…These pilot projects demonstrated this approach is not feasible. Cebollero et al ( Cebollero et al, 2020 ) studied the number of patients aged 18 to 26 who visited an urban area adult family planning clinic following a pharmacist led educational intervention. While no HPV doses were administered during the pre-intervention phase, 80 female patients were eligible for vaccination during the intervention period, 34 (42.5%) of whom received their first dose, 23 (28.8%) received the second dose, and six (7.5%) received the third dose, while at the clinic, and 46 (57.5%) patients were not vaccinated.…”

“…( Lutz et al, 2018 , Ryan et al, 2020 , Ko et al, 2014 , Shah et al, 2018 ) Researchers also recommended that more research needed on vaccine delivery in rural areas as these studies are so limited. ( Koskan et al, 2019 , Ryan et al, 2020 ) And virtually all the intervention studies indicated the more rigorous study designs, much larger studies, and much longer follow-up periods are needed to more fully understand the efficacy interventions designed to improve vaccine delivery and that these should include improved communication among stakeholders, including between primary care providers and pharmacists ( Hohmeier et al, 2016 , Calo et al, 2019 , Islam et al, 2017 , Doucette et al, 2019 , Islam et al, 2019 , Koskan et al, 2019 , Lutz et al, 2018 , Ryan et al, 2020 , Skiles et al, 2011 , Ko et al, 2014 , Shah et al, 2018 , Shah et al, 2018 , Shah et al, 2018 , Cebollero et al, 2020 ) and sustainable interventions ( Cebollero et al, 2020 ) that will continue after the intervention period is over.…”

“… Interventional Studies Calo WA, et al ( Calo et al, 2019 ) (2019) Mixed methods intervention small pilot studies conducted in five states (NC, MI, KY, IA, OR) Multiple states/regions Future research should involve integration strategies that will connect primary care and pharmacies in diverse settings. Cebollero J, et al ( Cebollero et al, 2020 ) (2020) Repeated measures pre-post study design with pharmacist led intervention in clinic with patient and healthcare provider education, prompt to EMR and clinic staff administered vaccines. Single Southeast Urban adult family planning clinic Future research should focus on iterative processes needed to sustain complete vaccine delivery.…”

Leveraging teachable moments in cancer prevention by improving HPV vaccination in health professional students (HPS): A systematic review

“…Strong recommendation for HPV vaccine by a healthcare provider has been positively associated with vaccine uptake (15). HPV vaccination can be obtained in a variety of settings beyond the doctor's office including schools (nurses) (16), pharmacies (17)(18)(19), and dental offices (20,21). Efforts to increase HPV vaccine uptake must be recognized as an interprofessional mission by empowering HPS in a variety of professions to become vaccine champions.…”