Using the 4 Pillars™ Practice Transformation Program to increase adolescent human papillomavirus, meningococcal, tetanus-diphtheria-pertussis and influenza vaccination

Abstract

Objectives To report the results of an intervention using the 4 Pillars™ Practice Transformation Program (4 Pillars™ Program) to increase adolescent vaccinations including human papillomavirus vaccine (HPV) and influenza vaccines, which remain underutilized in this population. Study Design Eleven pediatric and family medicine practices, previously control sites from a randomized controlled cluster trial, with ≥50 adolescent patients participated. The 4 Pillars™ Program was the foundation of the intervention. De-identified demographic, office visit and vaccination data were derived from electronic medical record extractions for patients whose date of birth was 4/1/1997 to 4/1/2004 (ages 11–17 years at baseline). Vaccination rates for HPV, influenza, tetanus-pertussis-diphtheria (Tdap) and meningococcal (MenACWY) vaccines were determined for all eligible patients pre- and post intervention (i.e., vaccination rates on 4/1/2015 and 4/30/2016). Results Among 9,473 patients ages 11–17 years at baseline (4/1/2015), mean pre-intervention vaccination rates for HPV initiation and completion, meningococcal, Tdap and influenza vaccines were below national levels. Rates increased significantly post intervention (P<0.001) for HPV initiation which increased 17.1 percentage points (PP) from 51.4%; HPV completion increased 14.8 PP from 30.7%, meningococcal vaccine uptake increased 16.6 PP from 79.1%, Tdap vaccine uptake increased 14.6 PP from 76.9%. Influenza vaccine uptake did not increase significantly (2.3 PP from 40.1%). In the regression using generalized estimating equations, odds of vaccination were higher for younger, non-white adolescents for all vaccines; being in a smaller practice decreased the odds of Tdap vaccination but increased the odds of influenza vaccination. Conclusion Clinically and statistically significant improvements in HPV series initiation and completion, and meningococcal and Tdap vaccinations were observed in primary care practices implementing the 4 Pillars™ Practice Transformation Program.

Recommending immunizations to adolescents in Turkey: a study of the knowledge, attitude, and practices of physicians

“…Web-based programs such as the Pillars™ Practice Transformation Program have been shown to be effective in expanding and maintaining vaccine coverage in adolescents. 17 The use of such programs in Turkey may improve the rate of adolescent immunization. Immunization is recommended for adolescents in many countries, but the desired vaccination rates are often not reached.…”

Dynamics of papillomavirus in vivo disease formation & susceptibility to high-level disinfection—Implications for transmission in clinical settings

“…High-risk HPV-driven neoplasia can result in the development of several human cancers, of which cervical cancer is the most prevalent. Current HPV vaccines are not therapeutic [1] , uptake has been variable (as low as 40% in the US and France) [ 2 , 3 ], and there remains no targeted antiviral therapy that can clear HPV-associated disease post-infection. High-risk HPVs are typically transmitted by close physical contact, but are stable in the environment and can be transmitted indirectly [4] , either as free virions or as virus-laden epithelial cells (squames) from fomite surfaces such as medical devices [ 5 , 6 ].…”

Why human papilloma virus vaccination coverage is low among adolescents in the US? A study of barriers for vaccination uptake

“…[3] Uptake of Meningococcal vaccine and Tdap (tetanus, diphtheria and pertussis) vaccine among adolescents has reached healthy people 2020 goals, but HPV vaccine has not. [5] A systematic review showed that adolescents had limited awareness and knowledge of HPV infections and vaccines, even 10 years after the vaccine had become available and they concluded that barriers to the uptake of vaccine needs to be addressed. [6] Since 2006, the vaccine has been approved for use in over 100 countries.…”