Identifying human papillomavirus vaccination practices among primary care providers of minority, low-income and immigrant patient populations

Abstract

Objective: Minority populations in the United States are disproportionally affected by human papillomavirus (HPV) infection and HPV-related cancer. We sought to understand physician practices, knowledge and beliefs that affect utilization of the HPV vaccine in primary care settings serving large minority populations in areas with increased rates of HPV-related cancer.

Study design: Cross-sectional survey of randomly selected primary care providers, including pediatricians, family practice physicians and internists, serving large minority populations in Brooklyn, N.Y. and in areas with higher than average cervical cancer rates.

Results: Of 156 physicians randomly selected, 121 eligible providers responded to the survey; 64% were pediatricians, 19% were internists and 17% were family practitioners. Thirty-four percent of respondents reported that they routinely offered HPV vaccine to their eligible patients. Seventy percent of physicians reported that the lack of preventive care visits for patients in the eligible age group limited their ability to recommend the HPV vaccine and 70% of those who reported this barrier do not routinely recommend HPV vaccine. The lack of time to educate parents about the HPV vaccine and cost of the vaccine to their patients were two commonly reported barriers that affected whether providers offered the vaccine.

Conclusions: Our study found that the majority of providers serving the highest risk populations for HPV infection and HPV-related cancers are not routinely recommending the HPV vaccine to their patients. Reasons for providers' failure to recommend the HPV vaccine routinely are identified and possible areas for targeted interventions to increase HPV vaccination rates are discussed.

Keywords: HPV vaccine and primary care providers; HPV vaccine barriers; Human papillomavirus vaccine.

Figure 1. Provider Recruitment Flow Chart

* A list of 552 physicians was compiled from data obtained from the New York State Department of Health provider database (http://www.nydoctorprofile.com/dispatch) and Local Chapters of the American Academy of Pediatrics, and included pediatricians, family practitioners, and internal medicine physicians serving neighborhoods identified from the American Community Survey as having large minority populations (greater than 30%) and higher than the average rates of HPV related cancer cases according to the New York State Cancer Registry. **Inclusion criteria: 1) New York State licensed general pediatrician, internal medicine or family practitioner, 2) minimum one-half of their patient population belong to minority populations (physician-reported), and 3) minimum one-third of their patient population were between the ages of 9 and 26 years old (physician-reported).