Pediatricians and nurse practitioners report using strategies to improve HPV vaccination
BALTIMORE - Pediatricians and nurse practitioners report using several strategies to improve human papillomavirus (HPV) vaccination, yet also perceive barriers, according to a national American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) network study. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24 - May 1 in Baltimore.
A safe and effective vaccine that prevents HPV-attributable cancers has been available since 2006. Despite demonstrated safety and effectiveness, coverage rates for the HPV vaccine remain suboptimal, and considerably lower than coverage for other adolescent vaccinations.
The study examined barriers to HPV vaccination and strategies used to improve HPV vaccination rates in a sample of pediatricians and nurse practitioners from 19 states who participate in the AAP's primary care practice-based research network. As part of the NIH-funded STOP HPV trial, the lead respondent from 47 practices recruited from the PROS research network completed an online, confidential survey in 2018. The survey measured office characteristics, standard office procedures for and communication about HPV vaccination, and use of evidence-based strategies such as performance feedback, prompts, reminder-recall, and standing orders. Proportions and medians were calculated for categorical and continuous variables, respectively.
All respondents reported more than one barrier to HPV vaccination. The most commonly reported major barrier was parent refusal or delay (over 80%). Respondents reported approximately 30% (range 5%-75%) of parents of their 11 to 12-yr-old patients due for an HPV vaccine refused and 15% (range 5%-60%) hesitated without refusing. Other major barriers reported by respondents included the time required to discuss HPV vaccination with families (17% of practitioners), low proportion of adolescents coming in for well visits (13%), lack of training in providing a strong recommendation (11%), respondents sense that others may view that HPV vaccination can wait (9%), and challenges associated with administering HPV vaccine at acute or chronic care visits (7%).
The most commonly reported strategy to improve HPV vaccination rates was use of prompts when HPV vaccination is needed (89%). Respondents also reported that their practices commonly use tools to improve communication about HPV vaccination with parents and adolescents (87%) and receive performance feedback about HPV vaccination rates (83%). Only 17% of respondents cited that their practice uses reminder-recall messages specific to the HPV vaccine.
The study concluded that respondent-perceived barriers to HPV vaccination remain. Practices are already using a wide variety of strategies to improve delivery of this vaccine, yet room for improvement remains. Alexander Fiks, MD, FAAP, MSCE, the senior author on the abstract, primary care pediatrician at Children's Hospital of Philadelphia, PROS Director and associate director of the Center for Pediatric Clinical Effectiveness and researcher at PolicyLab, added: "The ongoing STOP HPV trial will test the effectiveness of distinct strategies, alone or in combination, to overcome barriers to vaccination and, if effective, may ultimately minimize the burden of HPV-related disease."
Margaret Wright, PhD, one of the authors of the study, will present findings from "Pediatric Practitioners Report Using Strategies to Improve HPV Vaccination, yet Barriers Persist: Results from the National AAP Pediatric Research in Office Settings (PROS) Network" on Monday, April 29 at 10:30 a.m. EDT. Reporters interested in an interview with Dr. Fiks should contact PAS2019@piercom.com.
The PAS 2019 Meeting brings together thousands of pediatricians and other health care providers to improve the health and well-being of children worldwide. For more information about the PAS 2019 Meeting, please visit http://www.pas-meeting.org.
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About the Pediatric Academic Societies Meeting
The Pediatric Academic Societies (PAS) Meeting brings together thousands of pediatricians and other health care providers united by a common mission: to improve the health and well-being of children worldwide. This international gathering includes pediatric researchers, leaders in pediatric academics, clinical care providers and community practitioners. Presentations cover issues of interest to generalists as well as topics critical to a wide array of specialty and sub-specialty areas. The PAS Meeting will be the premier North American scholarly child health meeting. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting and #PAS2019, and like us on Facebook.
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Abstract: Pediatric Practitioners Report Using Strategies to Improve HPV Vaccination, yet Barriers Persist: Results from the National AAP Pediatric Research in Office Settings (PROS) Network
Background: A safe and effective vaccine that prevents HPV-attributable cancers has been available since 2006. Despite demonstrated safety and effectiveness, coverage rates for the HPV vaccine remain suboptimal, and considerably lower than coverage for other adolescent vaccinations.
Objective: Examine a) barriers to HPV vaccination and b) strategies used to improve HPV vaccination rates in a sample of pediatric primary care practitioners from 19 states.
Design/Methods: As part of the NIH-funded STOP HPV trial, the lead practitioner from 47 practices recruited from the PROS research network completed an online, confidential survey in 2018. The survey measured office characteristics, standard office practices for and communication about HPV vaccination, and use of evidence-based strategies such as performance feedback, practitioner prompts, reminder-recall, and standing orders. Proportions and medians were calculated for categorical and continuous variables, respectively.
Results: Barriers: All practitioners reported >1 barrier to HPV vaccination. The most commonly reported major barrier was parent refusal or delay (>80%, Table 1). Practitioners reported approximately 30% (range 5%-75%) of parents of their 11-12-yr-old patients due for a HPV vaccine refused and 15% (range 5%-60%) hesitated without refusing. Other major barriers reported by practitioners included the time required to discuss HPV vaccination with families (17% of practitioners), low proportion of adolescents coming in for well visits (13%), lack of training in providing a strong practitioner recommendation (11%), practitioners' view that HPV vaccination can wait (9%), and challenges associated with administering HPV vaccine at acute or chronic care visits (7%). Strategies: The most commonly reported strategy to improve HPV vaccination rates was use of prompts when HPV vaccination is needed (89%, Table 2). Practitioners also reported that their practices commonly use tools to improve communication about HPV vaccination with parents and adolescents (87%) and receive performance feedback about HPV vaccination rates (83%). Only 17% of practitioners cited that their practice uses reminder-recall messages specific to the HPV vaccine. Table 2 provides details about each specific strategy.
Conclusion(s): Practitioner-perceived barriers to HPV vaccination persist. Practices are already using a wide variety of strategies to improve delivery of this vaccine, yet room for improvement remains.
Authors (Last Name, First Name): Wright, Margaret; Shone, Laura P.; Humiston, Sharon G.; Steffes, Jennifer; Rand, Cynthia; Kelly, Mary Kate; Breck, Abigail; Localio, Russell; Stephens-Shields, Alisa J.; Grundmeier, Robert W.; Albertin, Christina; Abney, Dianna E.; McFarland, Greta; Szilagyi, Peter G.; Fiks, Alexander
Authors/Institutions: M. Wright, L.P. Shone, J. Steffes, D.E. Abney, G. McFarland, Research, American Academy of Pediatrics, Itasca, Illinois, UNITED STATES|S.G. Humiston, Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, UNITED STATES|C. Rand, C. Albertin, Pediatrics, University of Rochester, Rochester, New York, UNITED STATES|M. Kelly, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, UNITED STATES|A. Breck, University of California Los Angeles, Los Angeles, California, UNITED STATES|R. Localio, Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, UNITED STATES|A.J. Stephens-Shields, Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, UNITED STATES|R.W. Grundmeier, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, UNITED STATES|P.G. Szilagyi, Pediatrics, UCLA School of Medicine, Los Angeles, California, UNITED STATES|A. Fiks, Pediatrics, Children's Hospital Philadelphia, Philadelphia, Pennsylvania, UNITED STATES