Adolescent Immunization Practices

Schaffer, Stanley J.; Humiston, Sharon G.; Shone, Laura P.; Averhoff, Francisco; Szilâgyi, Peter G.

doi:10.1001/archpedi.155.5.566

Cited by 77 publications

(6 citation statements)

References 22 publications

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“…In general, pediatric clinics may be better equipped to administer childhood and adolescent vaccines given that they exclusively serve these populations. For example, pediatricians may be more accustomed to and knowledgeable about administering catch-up doses of childhood vaccines than are family practice clinicians [18–20]. Why HPV vaccine might pose an exception to this general trend is unclear, but our findings corroborate previous work showing higher HPV vaccine initiation and completion in family practice versus pediatric clinics [21].…”

Section: Discussionsupporting

confidence: 79%

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

Moss

Gilkey

Griffith

et al. 2013

Vaccine

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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.

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Section: Discussionsupporting

confidence: 79%

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

Moss

Gilkey

Griffith

et al. 2013

Vaccine

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“…Under the Supplementary insurance, the reimbursement was only 50 euro per dose (75 euro in case of preferential treatment). Reducing out of pocket costs has been shown to improve vaccination uptake for various children, adolescent and adult vaccines [4,12-15]. In addition, the administrative procedure of each of the reimbursement regimes might also have been important.…”

Section: Discussionmentioning

confidence: 99%

“…Socio-economic differences in HPV vaccination uptake are particularly relevant since people with low SES have a higher risk of contracting cervical cancer [23,24]. An obvious explanation might be the financial barrier caused by the co-payments [4,12-15]. However, most likely other reasons have also played a role, such as a differential influence of media attention on people with different socio-economic backgrounds or advertising being more directed to certain categories of people.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of HPV vaccination initiation in Flanders (Belgium) 2007-2009: a Cox regression model

et al. 2011

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BackgroundWe investigated dynamic patterns and predictors of HPV vaccination initiation in Flanders (Belgium) by girls aged 12 to 18, between 2007 and 2009, the period immediately after the introduction of the HPV vaccines on the Belgian market. During this period the initiative for vaccination was taken by the girl, her family or the general practitioner/pediatrician/gynecologist.MethodsWe used a Cox regression model with time constant and time varying predictors to model hazard rates of HPV vaccination initiation. The sample existed of 117,151 female members of the National Alliance of Christian Mutualities, the largest sickness fund in Flanders.ResultsThe study showed that the hazard of HPV vaccination initiation was higher (1) for older girls, (2) for girls with a more favorable socio-economic background, (3) under more generous reimbursement regimes (with this effect being more pronounced for girls with weak socioeconomic backgrounds), (4) for girls that were informed personally about the reimbursement rules.ConclusionsWhen the initiative for HPV vaccination lies with the girls, their families or the physicians (no organized setting) the uptake of the vaccines is affected by both individual and organizational factors.

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“…This may indicate that while pediatricians and family medicine physicians are receiving similar efforts for most of the AFIX-related quality improvement strategies, there is less emphasis in the long-term follow-up for family medicine. One possible explanation is that pediatric clinics account for the majority of general vaccinations administered 24,25 and have more infrastructure for data monitoring programs including systems to track undervaccinated children. 26 As with all of the variables, it is unclear what the temporal association is between HPV knowledge and AFIX-related activities.…”

Section: Discussionmentioning

confidence: 99%

Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination

Kasting

Christy

Sutton

et al. 2018

Preventive Medicine

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HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08-1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02-12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20-2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08-8.43), daily patient load (<20 vs. 20-24: aOR = 9.05;95%CI = 2.72-30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11-8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities.

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Adolescent Immunization Practices

Cited by 77 publications

References 22 publications

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

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

Dynamics of HPV vaccination initiation in Flanders (Belgium) 2007-2009: a Cox regression model

Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination

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