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More effective, timely HPV vaccine recommendations effective at increasing coverage rates

BALTIMORE – Improving the quality and increasing the frequency of HPV vaccine recommendations “drastically” increased overall series completion rates, according to data presented at the Pediatric Academic Societies Meeting.

“By now, many people are probably aware that the HPV vaccination rates for teenagers in this country are quite low, lagging way behind our goals as clinicians,” Landon B. Krantz, MD, of the Cincinnati Children’s Hospital Medical Center, in Ohio, said in an interview. “Our clinic performed a quality improvement project to increase HPV vaccination rates by first doing a self-audit of our own barriers to vaccination, and then implementing interventions to improve our providers' recommendations for the vaccine.”

Landon B. Krantz, MD

According to Krantz and his colleague, Mary Carol Burkhardt, MD, MHA, also of the Cincinnati Children’s Hospital Medical Center, a self-audit can provide clinicians with specific data on which to craft appropriate interventions to increase HPV vaccine completion rates.

“Our self-audit looked at multiple variables for each teenage clinic visit (e.g. age, gender, type of visit, et cetera) where an adolescent came in due for an HPV shot but didn't get the vaccine,” Krantz said. “This was counted as a ‘miss.’ Initially we were ‘missing’ over 20% of teenage visits even when excluding parent refusals, but after our interventions, we now vaccinate teenagers at 92% of visit opportunities.”

To increase their HPV vaccination rate during these clinic visits for teens visiting their clinic, the researchers obtained baseline immunization rates for all active patients aged 13 to 17 years, which included 488 males and 442 females.

They then examined variables for each adolescent visit in which an HPV vaccine was due, including age, gender, medical provider, visit type and parental refusal. First, the data were shared with the clinic’s staff in order to raise awareness of overall rates. Interventions were then crafted around the most common causes for various “misses.”

According to the researchers, baseline data for HPV vaccines among males showed 83.4% for 1 dose, 67.8% for 2 doses and 42.6% for a completed series. For females, the rates were 89.8% for 1 dose, 78.3% for 2 doses and 60% for a completed series. On average, 22.6 patients per week were due for an HPV vaccine dose, but only 73% of due patients, or 76% when excluding refusals, actually received the shot. A larger prevalence of HPV “misses” occurred during ill visits (P < .01) and ADHD visits (P < .01). Parental refusal rates ranged from 8% to 12%. Following interventions, focusing on specific types of visit types missed, weekly rates, not counting refusals, increased from 80% to 92% (range 74% to 95%, P = .037), and the number of teens returning each week for an HPV vaccine-only visit had doubled.

“The significant finding from our project is that by solely improving vaccine recommendation in quality and frequency, we drastically improved our overall rates, and now over 60% of our 1000 teenagers have completed their HPV series, compared to 39% of females and 21% of males nationally,” Krantz said. “This supports recent studies demonstrating that a lack of strong provider recommendation is a prominent barrier to vaccination. Therefore, just by giving a more effective and more timely vaccine recommendation, we significantly increased our population's HPV vaccination rates in only 10 months.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.

Reference:

Krantz LB, et al. A clinic’s audit: Using clinic-specific data to guide interventions for HPV vaccination. Presented at: Pediatric Academic Societies meeting; April 30 to May 3, 2016; Baltimore.