A new study finds that with the right patient engagement tools, clinicians can increase HPV immunization rates among teens.
Published in the May issue of JAMA Pediatrics, the study examined the impact of a communication intervention designed to help clinicians talk to patients and their parents about getting immunized against human papillomavirus, a sexually transmitted disease that causes nearly all cases of cervical cancer. More than 35,000 cases of HPV-related cervical cancer happen in the U.S. each year. And while rates of HPV vaccine uptake have been rising since the vaccine was first approved more than a decade ago, the most recent data find only about 60 percent of teens initiate the vaccine series.
“Attempts to use policy changes to increase uptake, such as mandating HPV vaccination for school entry, have been largely unsuccessful and ineffective,” researchers wrote. “Interventions to improve adolescent HPV vaccine uptake by other means are a national priority.”
In the new study, researchers evaluated the impact of a five-component communication training intervention for health providers. The intervention included a fact sheet library that clinical practices could use to create sheets tailored to their patient populations; a parent education website called “iVac”; a series of images of HPV-related disease; a decision aide on HPV immunization; and communication training for clinicians, including tips on motivational interviewing. The study, which notes that previous research shows that providers often fail to communicate effectively about vaccines, included 16 primary care practices in Denver, Colorado, consisting of nearly 200 medical professionals and more than 43,100 adolescent patients.
During the study period, February 2015 through January 2016, both practices that used the intervention and those that didn’t (the control group) reported an increase in adolescents starting the HPV vaccine series. However, the increases were significantly larger among the intervention group: vaccine initiation went up 1.8 percent among the control group, versus more than 11 percent among the intervention group. Intervention practices also reported significantly higher odds of patients completing the HPV vaccine series.
Researchers found the intervention had a greater impact within pediatric practices, compared to family medicine practices, and in private practices over public ones. Providers also reported that the communication training and fact sheets were the most used as well as most useful intervention components. In fact, 98 percent of health professionals said they were likely to continue using the fact sheets and 91 percent said they would likely continue using their newly acquired communication techniques.
Overall, the intervention resulted in a 9.5 percentage point increase in HPV vaccine initiation, compared to practices that didn’t receive the intervention. In addition, the intervention mitigated decreases in patients completing the entire HPV vaccine series. Researchers also noted that HPV vaccination primarily happened during well-child visits, with providers anecdotally reporting that lack of time made it harder to prioritize vaccines during sick visits.
“While there are examples of clinical systems that have successfully implemented routine adolescent HPV vaccination at sick visits, this practice is not widespread,” researchers wrote. “Given that adolescents see medical professionals for sick visits more commonly than for preventive visits, finding mechanisms to improve vaccination at sick visits is a clear research priority.”
To request a copy of the new HPV vaccine study, visit JAMA Pediatrics.