Human papillomavirus vaccine series follow-through: comparison of four clinics in an academic medical center

Abstract

ObjectiveThe Centers for Disease Control & Prevention (CDC) recommends that the human papillomavirus (HPV) vaccine series be initiated at ages 11–12 years, but many children never follow-through with the series. By examining differences in clinic-specific vaccine series follow-through rates across four clinics, we aimed to identify best practices related to communication around the vaccine and pathways to follow-through.MethodsWe used the electronic medical record (EMR) to retrospectively analyze HPV vaccine follow-through at four clinic settings. We limited the sample to children ages 11–17 who received a dose of the vaccine series at any of the clinics between January 2015 and June 2018. The primary outcome was follow-through of the HPV vaccine series within 18 months of initiation.ResultsA total of 3,813 patients were included in this study, 29% of which followed through with the HPV vaccine series. There was significant variability of vaccine follow-through among the clinics (p<0.001), with the Med/Peds clinic having the highest rate of follow-through (32%). After adjusting for confounding variables, multivariable analysis found that Med/Peds and Family Medicine had higher odds of HPV vaccine series follow-through than the Pediatrics clinic.ConclusionsWe found that the likelihood of vaccine series follow-through was highest when the series was started in the Med/Peds and Family Medicine clinics, compared to Pediatrics and Adolescent Medicine. These results suggest that further qualitative research is needed to understand what communication strategies are most effective at facilitating HPV vaccine uptake among adolescents, and how the most effective strategies can be shared among clinics.

Provider Continuity and Human Papillomavirus Vaccine Refusal Among Adolescents

“…We evaluated well visits to both clinics during 2019 for patients age 11 to 17 years, representing an age range seen in both clinics. 9 Well visits were identified using Current Procedural Terminology (CPT) codes 99381-99387 and 99391-99397. Because the volume of well visits was significantly greater in the General Pediatrics clinic, we used 1:1 exact matching without replacement on age (years), sex, and race/ethnicity (non-Hispanic Black; non-Hispanic White; Hispanic or Latino; all others) to identify a control (seen in the General Pediatrics clinic) for each case (seen in the Adolescent Medicine clinic) to create a matched sample for further analysis.…”

“…At our academic health center, adolescents visiting the General Pediatrics clinic are typically seen by different physicians at each visit, whereas adolescents visiting the Adolescent Medicine clinic are typically seen by the same physician over time. 9 We compared the 2 clinics to examine the relationship between provider continuity and HPV vaccination. Specifically, we hypothesized that HPV vaccinations offered during Adolescent Medicine clinic encounters would be less likely to be refused than vaccinations offered during general pediatrics clinic visits.…”