A recent study published in Pediatrics measured the impact of an intervention bundle on HPV vaccination rates in 24 primary care practices. (By way of disclosure, I am a proud co-author.) The study, “A Bundled, Practice-Based Intervention to Increase HPV Vaccination,” assessed differences in rates of HPV vaccination missed opportunities (i.e., visits when vaccine-eligible adolescents were not vaccinated). The study compared vaccination rates for a 12-month period before and a six-month period during this study’s intervention. The bundled intervention involved three components for clinicians: (1) online training on HPV vaccine communication, (2) feedback on their missed opportunities for HPV vaccination, and (3) prompts to order HPV vaccine.
This bundled intervention improved HPV vaccination during well childcare (WCC) visits but not during other visit types. Specifically, during WCC visits, missed HPV vaccination opportunities were improved (i.e., reduced during versus before the intervention). Missed opportunities for initial HPV vaccine doses decreased by 4.8% (95% CI, −7.2% to −2.4%) and for subsequent doses by 2.2% (95% CI, −4.4% to 0.0%).
No specific practice characteristics were associated with the decrease in missed opportunity rates. This suggests that the three-pronged intervention was effective in a way that was generalizable to different types of practices. A secondary analysis demonstrated that improvements were not attributable to any other major changes in U.S. healthcare, such as electronic health record upgrades or the patient population.
What did we learn?
The bundled intervention improved initial HPV vaccination rates at WCC visits by about the same amount as was found in a prior study in this series in which the only intervention was communication training. This suggests that communication training is a good first intervention for practices aiming to improve HPV vaccination rates.
Announcement approach
Communication has consistently been identified as an effective way to reduce missed opportunities for HPV vaccination (e.g., Dempsey and O’Leary; Dempsey, et. al.; Brewer, et. al.). The key component in communication training is introducing HPV vaccination through a clear announcement, also described as a presumptive message (e.g., “Today, Pat is due for HPV vaccination.”) rather than a “participatory” approach (e.g., “How would you feel about getting Pat vaccinated against HPV today?”). The announcement approach reduces parental hesitancy because it communicates that HPV vaccination is a routine recommendation. The authors note that communication training “should be a foundational element of any multicomponent intervention.” At office meetings, clinical personnel at participating offices discussed missed opportunity rates (motivation for improvement) and communication techniques they had tried (methodology for improvement). This helped to integrate the communication strategies into daily practice.
Well child versus acute and chronic visits
The bundled intervention did not lead to significant improvements in missed opportunity rates during acute or chronic visits, even for subsequent doses (during which parental hesitancy tends to be low). This replicates prior research demonstrating failure to improve vaccination rates during acute/chronic visits. Given the consistency of this finding, the authors recommend focusing on WCC “plus perhaps chronic care visits when more time may be available, and nursing visits for influenza vaccination, which focus on vaccination.”
Resources
- Shutting the Door on HPV Cancers: This is a 30-minute continuing education activity for physicians, pharmacists, physician assistants, nurses and nurse practitioners, available at no cost.
- Immunize Kansas Coalition HPV Vaccine Toolkit: Scroll down and check out the section on “Announcement/Presumptive Language.”
- “Vaccine Fears Overturned by Facts”: This booklet is a factual rebuttal with personal stories to address common vaccine myths. You can view the one-page summary for the booklet, single-question handouts, and the full “Vaccine Fears Overturned by Facts PDF.”
- Immunize.org’s HPV resources: These include ACIP recommendations, standing order templates, materials for vaccine recipients, and the “Ask the Experts: HPV” webpage.
Contributed by: Sharon G. Humiston, MD, MPH, FAAP
A recent study published in Pediatrics measured the impact of an intervention bundle on HPV vaccination rates in 24 primary care practices. (By way of disclosure, I am a proud co-author.) The study, “A Bundled, Practice-Based Intervention to Increase HPV Vaccination,” assessed differences in rates of HPV vaccination missed opportunities (i.e., visits when vaccine-eligible adolescents were not vaccinated). The study compared vaccination rates for a 12-month period before and a six-month period during this study’s intervention. The bundled intervention involved three components for clinicians: (1) online training on HPV vaccine communication, (2) feedback on their missed opportunities for HPV vaccination, and (3) prompts to order HPV vaccine.
This bundled intervention improved HPV vaccination during well childcare (WCC) visits but not during other visit types. Specifically, during WCC visits, missed HPV vaccination opportunities were improved (i.e., reduced during versus before the intervention). Missed opportunities for initial HPV vaccine doses decreased by 4.8% (95% CI, −7.2% to −2.4%) and for subsequent doses by 2.2% (95% CI, −4.4% to 0.0%).
No specific practice characteristics were associated with the decrease in missed opportunity rates. This suggests that the three-pronged intervention was effective in a way that was generalizable to different types of practices. A secondary analysis demonstrated that improvements were not attributable to any other major changes in U.S. healthcare, such as electronic health record upgrades or the patient population.
What did we learn?
The bundled intervention improved initial HPV vaccination rates at WCC visits by about the same amount as was found in a prior study in this series in which the only intervention was communication training. This suggests that communication training is a good first intervention for practices aiming to improve HPV vaccination rates.
Announcement approach
Communication has consistently been identified as an effective way to reduce missed opportunities for HPV vaccination (e.g., Dempsey and O’Leary; Dempsey, et. al.; Brewer, et. al.). The key component in communication training is introducing HPV vaccination through a clear announcement, also described as a presumptive message (e.g., “Today, Pat is due for HPV vaccination.”) rather than a “participatory” approach (e.g., “How would you feel about getting Pat vaccinated against HPV today?”). The announcement approach reduces parental hesitancy because it communicates that HPV vaccination is a routine recommendation. The authors note that communication training “should be a foundational element of any multicomponent intervention.” At office meetings, clinical personnel at participating offices discussed missed opportunity rates (motivation for improvement) and communication techniques they had tried (methodology for improvement). This helped to integrate the communication strategies into daily practice.
Well child versus acute and chronic visits
The bundled intervention did not lead to significant improvements in missed opportunity rates during acute or chronic visits, even for subsequent doses (during which parental hesitancy tends to be low). This replicates prior research demonstrating failure to improve vaccination rates during acute/chronic visits. Given the consistency of this finding, the authors recommend focusing on WCC “plus perhaps chronic care visits when more time may be available, and nursing visits for influenza vaccination, which focus on vaccination.”
Resources
- Shutting the Door on HPV Cancers: This is a 30-minute continuing education activity for physicians, pharmacists, physician assistants, nurses and nurse practitioners, available at no cost.
- Immunize Kansas Coalition HPV Vaccine Toolkit: Scroll down and check out the section on “Announcement/Presumptive Language.”
- “Vaccine Fears Overturned by Facts”: This booklet is a factual rebuttal with personal stories to address common vaccine myths. You can view the one-page summary for the booklet, single-question handouts, and the full “Vaccine Fears Overturned by Facts PDF.”
- Immunize.org’s HPV resources: These include ACIP recommendations, standing order templates, materials for vaccine recipients, and the “Ask the Experts: HPV” webpage.
Contributed by: Sharon G. Humiston, MD, MPH, FAAP