Organizational correlates of adolescent immunization: Findings of a state-wide study of primary care clinics in North Carolina

Abstract

Objective To analyze organization-level correlates of immunization coverage among adolescents served by high-volume primary care providers in North Carolina. Method We randomly selected 91 clinics with at least 200 active records for patients ages 11–18 in the North Carolina Immunization Registry. For the 105,121 adolescents served by these clinics, we obtained immunization status for 6 vaccines, including human papillomavirus (HPV) vaccine (females only); meningococcal conjugate; and tetanus, diphtheria, and pertussis booster (Tdap). Results Clinics specializing in pediatrics had higher coverage for meningococcal vaccine (OR = 1.79, 95% CI: 1.25–2.55), Tdap vaccine (OR = 1.22, 95% CI: 1.00–1.50), and childhood vaccines. However, pediatric clinics had lower coverage for HPV vaccine initiation (OR = 0.70, 95% CI: 0.52–0.94). Other correlates, which varied by vaccine, included policies related to vaccine documentation and the age at which clinics recommended vaccines. Conclusion Overall, adolescents were more likely to receive vaccines, except HPV vaccine, if they attended a pediatric clinic with supportive clinical policies.

Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review

“…Ten additional large database studies in the USA with multivariate analyses corroborate this association for both HPV and HBV vaccines [ 15 , 16 , 36 , 37 , 39 , 40 , 42 , 43 , 46 – 48 ]. However, no association between race and completion was found in 5 studies when controlling for gender, insurance and health clinic characteristics [ 29 , 38 , 45 , 49 , 50 ]. Hispanic adolescents were underrepresented in one survey with a low response rate [ 29 ].…”

“…In the USA, controlling for delivery site, age, insurance, year, chronic conditions and prior healthcare utilization, male gender was marginally associated with lower completion for varicella (aOR 0.93; 95 % CI 0.90–0.96), HAV (aOR 0.98; 0.97–0.99) and HBV (aOR 0.97; 0.96–0.98) [ 31 ]. Included studies did not report completion of HPV vaccine in boys, recommendations to vaccinate boys were issued in 2015 in the USA; however, clinics in the USA with higher female:male ratios obtained higher completion rates of HPV vaccine among females (aRR 2.16; 1.13–4.13) [ 49 ].…”

“…A further 17 studies investigated health provider characteristics, of which 12 reported adjusted analyses. There was no evidence that the speciality of an adolescent girl’s primary care physician influenced HPV series completion in multivariate analyses [ 15 , 16 , 36 , 42 , 49 , 55 ]. However, for women >17 years of age in the USA, those with a paediatric/internal medicine physician were slightly less likely to complete the HPV regimen than those with a family medicine physician.…”

HPV vaccination: Pilot study assessing characteristics of high and low performing primary care offices

“…Although clinician, parent/patient, and health system perspectives have been studied, we are unaware of studies which have comprehensively explored characteristics of medical offices with regard to HPV vaccination of adolescent patients. Offices with higher ratios of female to male adolescent patient demonstrated higher rates of HPV vaccine completion and HPV vaccination rates for adolescent patients are generally higher in pediatric compared to family medicine offices, although this has not been consistently observed in all studies ( Moss et al, 2013 ). However, clinician demographics do not differentiate between higher and lower performing offices ( Hudson et al, 2016 ).…”

Geospatial Patterns in Human Papillomavirus Vaccination Uptake: Evidence from Uninsured and Publicly Insured Children in North Carolina

“…Several barriers to HPV vaccination exist, including low levels of provider recommendation (14), parental concerns about the vaccine's effect on sexual behavior and perceptions of risk (14), religious affiliation (14), and low access to the health care system (15). Area-level variables associated with lower HPV vaccination rates include poverty (12,16), rural areas (15), pediatric specialty clinics (17), and distance to the place of vaccination (18).…”