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. 2018 Mar;18(2S):S85-S92.
doi: 10.1016/j.acap.2017.09.002.

Human Papillomavirus Vaccine Coverage and Prevalence of Missed Opportunities for Vaccination in an Integrated Healthcare System

Stephanie A Irving  1 , Holly C Groom  2 , Shannon Stokley  3 , Michael M McNeil  4 , Julianne Gee  4 , Ning Smith  2 , Allison L Naleway  2
Affiliations

Human Papillomavirus Vaccine Coverage and Prevalence of Missed Opportunities for Vaccination in an Integrated Healthcare System

Stephanie A Irving et al. Acad Pediatr. 2018 Mar.

Abstract

Background: Human papillomavirus (HPV) vaccination has been recommended in the United States for female and male adolescents since 2006 and 2011, respectively. Coverage rates are lower than those for other adolescent vaccines. The objective of this study was to evaluate an assessment and feedback intervention designed to increase HPV vaccination coverage and quantify missed opportunities for HPV vaccine initiation at preventive care visits.

Methods: We examined changes in HPV vaccination coverage and missed opportunities within the adolescent (11-17 years) population at 9 Oregon-based Kaiser Permanente Northwest outpatient clinics after an assessment and feedback intervention. Quarterly coverage rates were calculated for the adolescent populations at the clinics, according to age group (11-12 and 13-17 years), sex, and department (Pediatrics and Family Medicine). Comparison coverage assessments were calculated at 3 nonintervention (control) clinics. Missed opportunities for HPV vaccine initiation, defined as preventive care visits in which a patient eligible for HPV dose 1 remained unvaccinated, were examined according to sex and age group.

Results: An average of 29,021 adolescents were included in coverage assessments. Before the intervention, 1-dose and 3-dose quarterly coverage rates were increasing at intervention as well as at control clinics in both age groups. Postimplementation quarterly trends in 1-dose or 3-dose coverage did not differ significantly between intervention and control clinics for either age group. One-dose coverage rates among adolescents with Pediatrics providers were significantly higher than those with Family Medicine providers (56% vs 41% for 11- to 12-year-old and 82% vs 69% for 13- to 17-year-old girls; 55% vs 40% for 11- to 12-year-old and 78% vs 62% for 13- to 17-year-old boys).

Conclusions: No significant differences in HPV vaccine coverage were identified at intervention clinics. However, coverage rates were increasing before the start of the intervention and might have been influenced by ongoing health system best practices. HPV vaccine coverage rates varied significantly according to department, which could allow for targeted improvement opportunities.

Keywords: adolescent; human papillomavirus vaccine; vaccine coverage; vaccine initiation.

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Conflict of interest statement

Ms Irving reports unrelated research support from Medimmune; Ms Groom reports unrelated research support from Merck, and Dr Naleway reports unrelated research support from Merck, Medimmune, and Pfizer. The remaining authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
One (≥7) dose human papillomavirus (HPV) vaccination coverage rates according to age group, sex, and clinic type (intervention or control). Vertical line marks start of Boosting Recommended Adolescent Vaccination in Oregon (BRAVO) intervention period.
Figure 2.
Figure 2.
Three (≥3) dose human papillomavirus (HPV) vaccination coverage rates according to age group, sex, and clinic type (intervention or control). Vertical line marks start of Boosting Recommended Adolescent Vaccination in Oregon (BRAVO) intervention period.
See this image and copyright information in PMC

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References

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