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

Abstract

This pilot study was undertaken to identify characteristics and approaches (e.g., social, behavioral, and/or systems factors) which differentiate primary care medical offices achieving higher rates of HPV vaccination.Eligible primary care practice sites providing care to adolescent patients were recruited within an eight county region of western New York State between June 2016 and July 2016. Practice sites were categorized as higher (n = 3) or lower performing (n = 2) based on three dose series completion rates for HPV vaccinations among females aged 13–17 years. Interviewer administered surveys were completed with office staff (n = 37) and focused on understanding approaches to adolescent vaccination. Results were summarized using basic descriptive statistics.Higher performing offices reported more full-time clinical staff (median = 25 vs. 9.5 in lower performing clinics), larger panels of patients ages 11–17 years (median = 3541 vs. 925) and completion of NYSIIS data entry within two weeks of vaccination. (less than a month vs. two). Staff in higher performing offices reviewed medical charts prior to scheduled visits (100% vs. 50) and identified their office vaccine champion as a physician and/or a nurse manager (75% vs. 22%). Also, staffs from higher performing offices were more likely to report the combination of having an office vaccine champion, previewing charts and using standing orders. These preliminary findings support future research examining implementation of organizational processes including identifying a vaccine champion, using standing orders and previewing medical charts prior to office visits as strategies to increase rates of HPV vaccination in primary care offices.

Implementation and evaluation of a multilevel intervention to increase uptake of the human papillomavirus vaccine among rural adolescents

“…His support ensured that providers and clinic staff were on the same page regarding HPV vaccinations and helped create a pro‐HPV‐vaccination clinic culture. This finding supports research that suggest a team‐based approach coupled with a vaccine champion can contribute to higher uptake of the HPV vaccine 21,31–33 …”

“…Our ML intervention included evidence‐ and practice‐based strategies that have been shown to have an impact on HPV vaccination rates: (1) patient postcard reminders; (2) parent and clinic educational resources; (3) a clinic immunization champion; (4) a clinic‐wide team‐based HPV vaccination recommendation approach; (5) in‐service trainings for all clinic team members; and (6) routine assessment and review of clinic HPV vaccination rates 11–16,21,26 . This study adds to the growing body of literature that suggests that the development and testing of ML and integrative approaches to address HPV vaccine hesitancy is needed to maximize impact on vaccination initiation and completion rates 28–31 . Our findings are consistent with a narrative review of HPV vaccination interventions in rural US communities, which reported that among the 12 studies using experimental designs that had positive HPV vaccination outcomes, 7 studies used ML intervention conditions 17 …”

Identifying Strategies to Reduce Missed Opportunities for HPV Vaccination in Primary Care: A Qualitative Study of Positive Deviants

“…While use of standing orders has been associated with higher vaccination rates, 50,51 they were considered to be challenging to implement in many practices, and the concept was misinterpreted by many, despite resources provided by the project. 52 In addition, there was resistance from some providers for nurses to introduce the HPV vaccine without provider input at the encounter.…”

What Impacts HPV Vaccination Recommendations? An Exploration of Medical Residents’ Knowledge, Training, Barriers, and Practices

“…Primary care offices with higher HPVV rates report workflow ease surrounding HPVV including standing orders and chart preparation. 25 Such practices at the Peds resident clinic undoubtedly contribute to a culture that promotes high rates of vaccination.…”