Missed clinical opportunities: Provider recommendations for HPV vaccination for 11–12 year old girls are limited

Abstract

Objective The purpose of this study was to determine the prevalence of physician recommendation of human papillomavirus (HPV) vaccination in early (ages 11-12), middle (13-17), and late adolescent/young adult (18-26) female patients by physician specialty, and to identify factors associated with recommendation in early adolescents. Methods A 38-item survey was conducted April 2009 through August 2009 among a nationally representative random sample of 1,538 Family Physicians, Pediatricians, and Obstetricians and Gynecologists obtained from the American Medical Association Physician Masterfile. A multivariable model was used to assess factors associated with frequency of physician recommendation of HPV vaccination (“always”=76-100% of the time vs. other=0-75%) within the past 12 months. Results Completed surveys were received from 1,013 physicians, including 500 Family Physicians, 287 Pediatricians, and 226 Obstetricians and Gynecologists (response rate = 67.8%). Across the specialties, 34.6% of physicians reported they “always” recommend the HPV vaccine to early adolescents, 52.7% to middle adolescents, and 50.2% to late adolescents/young adults. The likelihood of “always” recommending the HPV vaccine was highest among Pediatricians for all age groups (P < .001). Physician specialty, age, ethnicity, reported barriers, and Vaccines for Children provider status were significantly associated with “always” recommending HPV vaccination for early adolescents. Conclusions Findings suggest missed clinical opportunities for HPV vaccination, and perceived barriers to vaccination may drive decisions about recommendation. Results suggest the need for age and specialty targeted practice and policy level interventions to increase HPV vaccination among US females.

Provider communication about HPV vaccination: A systematic review

“…30,45,47 Studies assessing the relationship between provider characteristics and HPV vaccine recommendations most often focused on clinical specialty and demographics. Most studies found that pediatricians reported more positive HPV vaccine recommendation practices than family physicians 9,11,12,30,33,[48][49][50][51] or other types of providers. 12,32 Other studies failed to find variation in recommendations by specialty, 23,[34][35][36]40,52,53 but several of these studies did not include pediatricians.…”

“…12,32 Other studies failed to find variation in recommendations by specialty, 23,[34][35][36]40,52,53 but several of these studies did not include pediatricians. 34,52,53 Most studies did not find variation in HPV vaccine recommendations by provider sex, 9,23,30,36,39,44,[47][48][49]54 but those that did most often favored female providers. 24,25,29,33,53 Similarly, most studies did not find variation in HPV vaccine recommendations by provider age or years in practice, 30,33,36,47,49 although a few did with mixed results.…”

“…24,25,29,33,53 Similarly, most studies did not find variation in HPV vaccine recommendations by provider age or years in practice, 30,33,36,47,49 although a few did with mixed results. 9,24,50 Studies assessing provider race/ethnicity suggested that minority status was associated with recommending HPV vaccine. 9,30,32,34 Studies of clinic or practice-level characteristics focused on the composition of patient populations in terms of race/ethnicity, insurance type, and geographic location.…”

“…[4][5][6][7] However, around half of age-eligible adolescents do not receive recommendations. [8][9][10] Furthermore, a growing body of research suggests that those recommendation adolescents do receive are weaker than recommendations for other adolescent vaccines, such as tetanus, diphtheria, and acellular pertussis (Tdap) and meningococcal vaccines. 11,12 Understanding and improving provider communication, particularly with regard to recommendations, is imperative to increasing HPV vaccination coverage.…”

Knowledge and Attitudes about Human Papillomaviruses and Immunization among Turkish Pediatricians

“…Several HPV vaccines have been developed, including a bivalent (strains 16 and 18) and a quadrivalent (strains 16, 18, 6, and 11) vaccine (Harper et al, 2004;Villa et al, 2005;Harper et al, 2006). The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of girls aged 11-12 years, as well as for those aged 13-26 years who have not been previously vaccinated (Markowitz et al, 2007;Vadaparampil et al, 2011). A quadrivalent vaccine was licensed by the US Food and Drug Administration (FDA) for use in males 9 through 26 years of age in 2009 (American Academy of Pediatrics, 2012).…”