Impact of an Electronic Health Record (EHR) Reminder on Human Papillomavirus (HPV) Vaccine Initiation and Timely Completion

Ruffin, Mack T.; Plegue, Melissa; Rockwell, Pamela G; Young, Alisa P.; Patel, Divya; Yeazel, Mark W.

doi:10.3122/jabfm.2015.03.140082

Cited by 68 publications

(54 citation statements)

References 25 publications

(30 reference statements)

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“…The authors suggested that this combined strategy may have supported the creation of a common agenda that facilitates HPV vaccine series initiation. (48) A recent literature review of interventions to increase HPV vaccination rates suggested that there was sufficient evidence to support the use of Community Preventive Task Force recommendations related to client reminder and recall systems as well as provider assessment and feedback. (49) Thus, future interventions may benefit from considering point-of-care reminders that simultaneously prompt physicians and patients to discuss HPV vaccination.…”

Section: Discussionmentioning

confidence: 99%

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

Vadaparampil

Malo

Sutton

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the U.S. are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males. Methods We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11–12, 13–17, 18–21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with of consistent and strong recommendations for 11–12 year olds. Results We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males 13–17 (39%) compared to ages 11–12 (31%) and 18–21 (31%). Consistent and strong recommendation for 11–12 year old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty remembering to discuss HPV vaccination. Conclusion Physicians’ current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians’ personal barriers to HPV vaccine delivery. Impact As one of the first studies to examine both consistency and strength of physicians’ HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians’ recommendations.

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Section: Discussionmentioning

confidence: 99%

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

Vadaparampil

Malo

Sutton

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Guideline implementation likely will require a multifaceted approach 24 and computer reminders represent a promising component for successful implementation. 25 Electronic health record prompts already show potential for improving HPV vaccine uptake; 26 incorporating reminders about practice guidelines may also facilitate improved HPV vaccine recommendations.…”

Section: Discussionmentioning

confidence: 99%

Primary Care Physicians' Adherence to Expert Recommendations for Cervical Cancer Screening and Prevention in the Context of Human Papillomavirus Vaccination

et al. 2016

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Background Expert recommendations do not recommend using Pap or human papillomavirus (HPV) test results to determine whether unvaccinated females should receive HPV vaccine, nor do they recommend using vaccine receipt to inform cervical cancer screening practices. This study characterizes physicians’ HPV vaccine recommendations and practices in the context of HPV and Pap testing. Methods We surveyed family physicians and obstetrician-gynecologists randomly selected from the American Medical Association Masterfile in 2011 (n = 574). Physicians used a 5-point scale (never to always) to report the frequency of (1) using HPV testing results to decide whether to recommend HPV vaccine, and (2) recommending HPV vaccination to females (≤26 years) who had an abnormal Pap test. Physicians also reported (3) intention to change Pap screening frequency for vaccinated females. Results Across both specialties, 80% correctly reported rarely or never using HPV testing results to guide vaccine recommendations; 66% often or always recommended vaccination to patients with an abnormal Pap result; and 77% did not plan to change Pap screening frequency for vaccinated females. About 41% reported recommendation-consistent practices with all three measures. In multivariable analysis, obstetrician-gynecologist specialty and private practice type were associated with higher average overall adherence to recommendations. Conclusions Contrary to expert recommendations, a considerable minority of physicians reported recommending HPV vaccination based on HPV and Pap test results. If these clinical practices persist, many young adult women will not realize the benefits of HPV vaccination. Additional efforts are needed to ensure all young women are screened and vaccinated appropriately.

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“…Similarly, two relatively intensive multi-component provider-focused interventions also resulted in significant, though somewhat modest increases in HPV vaccination rates (18,19). Using a retrospective cohort design, Ruffin and colleagues found that practices that had an EHR reminder prompt system had higher HPV vaccine rates than practices without an EHR prompt (20). In contrast, a recently published randomized study of EHR prompts found that they had no effect on HPV vaccination rates (21).…”

mentioning

confidence: 89%

“A Day Late and a Dollar Short”: Physicians and HPV Vaccination

Zimet

2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

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The results of the 2014 U.S. National Immunization SurveyTeen (NIS-Teen) indicated very modest increases in human papilloma virus (HPV) vaccination rates for 13-to 17-year-old females, with series initiation at 60%, a 3.3% increase over 2013 (1). Furthermore, among girls who initiated vaccination, the 3-dose completion rate actually dropped very slightly from 69.8% in 2013 to 69.3% in 2014. For males, initiation of HPV vaccination was 41.7%, an 8.1% increase over the 2013 rate. Among boys who initiated vaccination, the 3-dose completion rate also improved from 48.2% in 2013 to 57.8% in 2014. It is important to note that rates for the targeted ages of 11 to 12 years are even lower. Clearly, we are far from meeting the Healthy People 2020 goal of 80% 3-dose coverage for HPV vaccination (2). It is well-recognized and documented that a strong, routine health care provider (HCP) recommendation is associated with higher rates of HPV vaccination (3, 4). Conversely, parents frequently cite the lack of an HCP recommendation or a weak recommendation as among the most important reasons for nonvaccination of sons and daughters (5, 6).The research reported by Gilkey and colleagues (7) in this issue of Cancer Epidemiology, Biomarkers & Prevention represents an important contribution to the growing body of information on HPV vaccination practices of primary care physicians, a topic previously addressed in reviews of the literature (6,8) and in recent research publications (9-14). As in these other research studies, Gilkey and colleagues, via a national survey of pediatricians and family physicians, found that many of these HCPs were inconsistent in their approaches to HPV vaccination, often delayed vaccination past the recommended ages of 11 to 12 years, and generally failed to strongly recommend vaccination. A unique element of this research paper is the development of an index of overall HPV vaccination recommendation quality, an approach that may prove valuable, conceptually, in the development and implementation of interventions to improve the effectiveness of HPV vaccine recommendations. The dimensions that make up the quality index are: timeliness (HPV vaccine recommendation at 11-12 years of age); consistency (recommending vaccination of all eligible children, not using a risk-based approach); urgency (recommending same-day vaccination); and strength of endorsement (emphasizing the importance of HPV vaccination). The authors note that about half of the physicians they surveyed self-reported at least two lower quality approaches to HPV vaccine communication. It is particularly noteworthy that over half used risk-based approaches to HPV vaccination, recommending the vaccine based on a sense of a child's behavioral risk for HPV infection, which is not an effective approach to vaccination.There are a number of lessons to be taken from this study. First of all, though the findings indicate generally problematic approaches to HPV vaccination, the results are based on selfreport surveys, which may have been subject to social d...

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Impact of an Electronic Health Record (EHR) Reminder on Human Papillomavirus (HPV) Vaccine Initiation and Timely Completion

Cited by 68 publications

References 25 publications

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

Primary Care Physicians' Adherence to Expert Recommendations for Cervical Cancer Screening and Prevention in the Context of Human Papillomavirus Vaccination

“A Day Late and a Dollar Short”: Physicians and HPV Vaccination

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