Parent reminder, health care professional audit increased adolescent HPV vaccination

Key takeaways:

• HPV vaccine uptake increased when using reminder/recall alone and reminder/recall plus audit/feedback interventions.
• Uptake with audit/feedback alone did not significantly differ from that with usual care.

Implementation of parent reminder/recall and health care professional audit/feedback increased HPV vaccination uptake compared with usual care approaches, according to study results published in JAMA Pediatrics.

“Reminder/recall alerts patients or parents of children due or past due for vaccination. Audit/feedback informs health care professionals about their vaccination performance,” Lila J. Finney Rutten, PhD, MPH, professor of health sciences research and chair of the division of epidemiology at Mayo Clinic, and colleagues wrote. “Given that all of the practices in our study had already adopted other effective strategies to improve HPV vaccination ... we sought to ascertain the independent and synergistic impact of implementation of these evidence-based interventions on HPV vaccination rates.”

Finney Rutten and colleagues conducted a cluster-randomized trial of children aged 11 and 12 years (52.5% boys). All participants were from six primary care practices affiliated with Mayo Clinic in southeastern Minnesota. Each practice was randomly assigned to a sequence of the initial baseline step followed by neither, one or both interventions and a final step wherein all practices implemented both interventions simultaneously. All children who turned 11 or 12 years old were identified and followed monthly.

The reminder/recall intervention included reminders of all vaccinations required sent by mail after the child’s birthday, with sources for additional information. This method used presumptive language conveying strong recommendations for vaccines due, descriptions of availability of topical anesthetics to reduce pain and emphasizing nurse visit convenience. The audit/feedback intervention involved health care professionals receiving confidential responses on their personal in-office success with HPV vaccine uptake via intra-campus mail.

Overall, the study included 5,165 children aged 11 years and 4,077 aged 12 years. The reminder/recall intervention resulted in 34.6% of children receiving an HPV vaccine dose, and the audit/feedback intervention resulted in 30.4% receiving the vaccine compared with 21.9% with usual care. When utilizing both the reminder/recall and audit/feedback interventions, the HPV vaccine uptake rate rose to 39.7%.

HPV vaccination odds were higher when using the reminder/recall intervention (OR = 1.56; 95% CI, 1.23-1.97) and when using the combination of the reminder/recall and audit/feedback interventions (OR = 2.03; 95% CI, 1.44-2.85) compared with usual care.

Researchers noted that utilization of the health care professional audit/feedback intervention alone did not significantly differ from the usual care approach.

“We recommend practices adopt reminder/recall to draw patients into the practice for encounters and audit/feedback to encourage use of every encounter to vaccinate,” the researchers wrote. “Future pediatric research may consider the utility of such interventions for other preventive measures.”