Outreach and Reminders to Improve Human Papillomavirus Vaccination in an Integrated Primary Care System

Abstract

This study evaluated the impact of health system-based outreach and reminders on human papillomavirus (HPV) vaccine series initiation and completion. Parents of 10 to 12 year olds (n = 1805) were randomized to receive either (1) an outreach letter and brochure recommending HPV vaccination followed by automated HPV vaccine reminders or (2) usual care. We interviewed a subset of 50 parents to assess program acceptability. Outcomes were HPV vaccine initiation during the study period and on-time series completion. Rates of HPV vaccine initiation during the study period (July 2015 to August 2016) were similar between the intervention and control groups, but initiation within 120 days of randomization was higher in the intervention group (23.6% and 18.8%, P = .04) as was completion during the study period (10.3% vs 6.8%, P = .04). Reminders for doses 2 and 3 did not affect completion. The program was acceptable to parents. This study provides evidence that health system-based outreach and reminders can improve HPV vaccination.

Strategies to improve human papillomavirus vaccination rates among adolescents in family practice settings in the United States: A systematic review

“…Reported HPV vaccine series completion rates also varied between studies (Table 5). Generally, series completion rates improved in the intervention group compared with the control group (Cates et al, 2018; Henrikson et al, 2018; McGaffey et al; Perkins et al, 2020; Zimmerman et al, 2017). Studies by McClean et al (2017) and Szilagyi et al (2015, 2020) did not demonstrate any improvement with the interventions implemented.…”

“…Reported HPV vaccine series initiation rates varied between studies (Tables 4 and 5). Overall, vaccine series initiation rates improved in the intervention group compared with the control group (Bar‐Shain et al, 2015; Henrikson et al, 2018; McGaffey et al, 2018; Perkins et al, 2020; Rand et al, 2017; Zimmerman et al, 2017) ; however, McClean et al (2017) noted that children in the age group of 13–17 years were not significantly influenced by the intervention, while children in the age group of 11–12 years were significantly influenced. Szilagyi et al (2020) only reported improvement in initiation rates following a single phone call in Colorado practices, but otherwise did not report any improvements following intervention.…”

“…Six studies reported that reminders in the form of text messages, emails or letters served as facilitators for successful vaccination (Bar‐Shain et al, 2015; Henrikson et al, 2018; McLean et al, 2017; Perkins et al, 2020; Rand et al, 2017; Zimmerman et al, 2017). Henrikson et al (2018), McLean et al (2017), and Perkins et al (2020) reported that education at the time of visits also contributed to successful vaccinations. Vaccination rates by gender were conflicting, with Cates et al (2018) and McGaffey et al (2018) finding that boys had a better vaccination rate than girls, while Rand et al (2017) and Zimmerman et al (2017) reporting the contrary.…”

“…Those who did report barriers indicated that parental prejudice against vaccination (Henrikson et al, 2018), lack of insurance coverage (Dempsey et al, 2019; Zimmerman et al, 2017) and inadequate reminders from healthcare personnel (Szilagyi et al, 2015) all contributed to patients not getting vaccinated. Male participants who viewed HPV as a ‘woman's problem’ were also less likely to receive vaccination (Henrikson et al, 2018). Lastly, patients who went to family practices were vaccinated more often than those who sought care through paediatric settings (Rand et al, 2017).…”

“…Measures were also implemented following office visits in which HPV vaccination was recommended. Reported interventions included reminders to patients using various mechanisms of communication, such as emails, text messages, voicemails, postcards and online resources (Table 4) (Bar‐Shain et al, 2015; Henrikson et al, 2018; McClean et al, 2017; McGaffey et al, 2019; Perkins et al, 2020; Rand et al, 2017; Zimmerman et al, 2017). Online educational resources about HPV vaccination were also provided to patients following office visits (Cates et al, 2018).…”