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A Clinical Educational Intervention to Increase HPV Vaccination Rates Among Pediatric Patients Through Enhanced Recommendations

Published:August 03, 2022DOI:https://doi.org/10.1016/j.pedhc.2022.07.003

      Introduction

      The human papillomavirus (HPV) causes largely preventable cancers by completing a vaccination series. However, pediatric HPV vaccination rates remain low. Current evidence indicates that integrating five factors creates a high-quality recommendation associated with higher HPV vaccination rates. This quality improvement project aimed to evaluate the impact of an educational intervention to improve the quality of providers’ recommendations and subsequent vaccination rates.

      Method

      Using the Squire 2.0 Guidelines, clinical staff were observed during well-child visits (aged 11–12 years) before and after the intervention across three Plan-Do-Study-Act cycles.

      Results

      Thirty-nine encounters with mostly (n = 31; 80%) families of color. The quality of vaccine recommendations was improved after the intervention; however, vaccination rates did not increase for the 39 patients. Providers’ delivery approach (presumptive vs. conversational) did increase vaccination rates.

      Discussion

      Providers’ delivery style appears to be important when making HPV vaccine recommendations.

      KEY WORDS

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      References

        • Bajaj S.S.
        • Stanford F.C.
        Beyond Tuskegee—Vaccine distrust and everyday racism.
        New England Journal of Medicine. 2021; 384: e12
        • Brewer N.T.
        • Hall M.E.
        • Malo T.L.
        • Gilkey M.B.
        • Quinn B.
        • Lathren C.
        Announcements versus conversations to improve HPV vaccination coverage: A randomized trial.
        Pediatrics. 2017; 139: 1-9
      1. Centers for Disease Control and Prevention. (2019a). Dr. Todd Wolynn describes how he recommends HPV vaccine. Retrieved from https://youtu.be/wOKV4eEcTzU

      2. Centers for Disease Control and Prevention. (2019b). How many cancers are linked to HPV each year? Retrieved from https://www.cdc.gov/cancer/hpv/statistics/cases.htm

      3. Centers for Disease Control and Prevention. (2019c). Talking to parents about HPV vaccine. Retrieved from https://www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf

      4. Centers for Disease Control and Prevention. (2019d). HPV vaccine schedule and dosing. Retrieved from https://www.cdc.gov/hpv/hcp/schedules-recommendations.html

      5. Centers for Disease Control and Prevention/National Center for Immunization and Respiratory Diseases. (2018). National immunization survey – Teen (NIS-Teen). Retrieved fromhttps://health.gov/healthypeople/objectives-and-data/data-sources-and-methods/data-sources/national-immunization-survey-teen-nis-teen

        • Chuang E.
        • Cabrera C.
        • Mak S.
        • Glenn B.
        • Hochman M.
        • Bastani R.
        Primary care team- and clinic level factors affecting HPV vaccine uptake.
        Vaccine. 2017; 35: 4540-4547
        • Dang J.H.T.
        • Stewart S.L.
        • Blumberg D.A.
        • Rodriguez H.P.
        • Chen M.S.
        ‘There's always next year’: Primary care team and parent perspectives on the human papillomavirus vaccine.
        Human Vaccines and Immunotherapeutics. 2020; 16: 1814-1823
        • Finney Rutten L.J.
        • St Sauver J.L.
        • Beebe T.J.
        • Wilson P.M.
        • Jacobson D.J.
        • Fan C.
        • Jacobson R.M.
        Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children.
        Vaccine. 2017; 35: 6122-6128
        • Fontenot H.B.
        • Kornides M.L.
        • McRee A.L.
        • Gilkey M.B.
        Importance of a team approach to recommending the human papillomavirus vaccination.
        Journal of the American Association of Nurse Practitioners. 2018; 30: 368-372
        • Gilkey M.B.
        • Malo T.L.
        • Shah P.D.
        • Hall M.E.
        • Brewer N.T.
        Quality of physician communication about human papillomavirus vaccine: Findings from a national survey.
        Cancer Epidemiology, Biomarkers and Prevention. 2015; 24: 1673-1679
      6. Healthy People 2030. (n.d.). Increase the proportion of adolescents who get recommended doses of the HPV vaccine—IID08. Retrieved fromhttps://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08

        • Kempe A.
        • O'Leary S.T.
        • Markowitz L.E.
        • Crane L.A.
        • Hurley L.P.
        • Brtnikova M.
        • Lindley M.C.
        HPV vaccine delivery practices by primary care physicians.
        Pediatrics. 2019; 144: 1-14
        • Langley G.J.
        • Moen R.D.
        • Nolan K.M.
        • Nolan T.W.
        • Norman C.L.
        • Provost L.P.
        The improvement guide: A practical approach to enhancing organizational performance.
        2nd ed. Wiley, Chichester, United Kingdom2009
        • Ogrinc G.
        • Davies L.
        • Goodman D.
        • Batalden P.B.
        • Davidoff F.
        • Stevens D.
        SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process.
        BMJ Quality and Safety. 2016; 25: 986-992
      7. Oregon Health Authority. (2020). Oregon adolescent immunization rates. Retrieved fromhttps://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/VACCINESIMMUNIZATION/Pages/researchteen.aspx

        • Rahman M.
        • Hirth J.M.
        • Berenson A.B.
        Adherence to ACIP recommendation for human papillomavirus vaccine among US adolescent girls.
        Journal of Community Health. 2017; 42: 385-389
        • Reno J.E.
        • O'Leary S.T.
        • Pyrzanowski J.
        • Lockhart S.
        • Thomas J.
        • Dempsey A.F
        Evaluation of the implementation of a multicomponent intervention to improve health care provider communication about human papillomavirus vaccination.
        Academic Pediatrics. 2018; 18: 882-888
        • Santoli J.M.
        • Lindley M.C.
        • DeSilva M.B.
        • Kharbanda E.O.
        • Daley M.F.
        • Galloway L.
        • Weintraub E.
        Effects of the COVID-19 Pandemic on routine pediatric vaccine ordering and administration—United States, 2020.
        MMWR. Morbidity and Mortality Weekly Report. 2020; 69: 591-593
        • Signorelli C.
        • Odone A.
        • Ciorba V.
        • Cella P.
        • Audisio R.A.
        • Lombardi A.
        • Peracino A.
        Human papillomavirus 9-valent vaccine for cancer prevention: A systematic review of the available evidence.
        Epidemiology and Infection. 2017; 145: 1962-1982
        • Sturm L.
        • Donahue K.
        • Kasting M.
        • Kulkarni A.
        • Brewer N.T.
        • Zimet G.D.
        Pediatrician-parent conversations about human papillomavirus vaccination: An analysis of audio recordings.
        Journal of Adolescent Health. 2017; 61: 246-251