Treating HPV vaccine as ‘routine’ ups vaccination rate

PHILADELPHIA– A “routine recommendation” approach was the most effective but least used strategy for promoting same-day human papillomavirus vaccination in adolescent boys and girls, according to an industry-funded study of more than 150 well-visit interactions.

Of 204 well visits with 20 pediatricians, 167 (82%) involved discussion of adolescent vaccination, and 152 (75%) specifically mentioned HPV vaccination.

Vaccine recommendation approaches used in the recorded visits were categorized into three styles: “routine recommendation,” which was used in 11% of visits, yielding a 94% same-day vaccination rate; “brief mention,” which was used in 17% of visits, yielding a 27% same-day vaccination rate; and “detailed discussion,” which was used in 72% of visits, yielding a 38% same-day vaccination rate, Dr. Liana R. Clark reported at an annual scientific meeting on infectious diseases.

More specifically, the routine recommendation approach was used during 15% of visits with 32 girls aged 11-12 years, 7% of visits with 42 boys aged 11-12 years, and 10% of visits with 78 boys aged 13-18 years, yielding same-day vaccination rates of 80%, 100%, and 100%, respectively.

The brief intervention approach was used in 19%, 29%, and 13% of the visits, yielding same-day vaccination rates of 17%, 8%, and 20%, respectively. And the detailed discussion approach was used in 66%, 64%, and 77% of the visits, yielding same-day vaccination rates of 19%, 33%, and 47%, respectively, Dr. Clark of Merck Vaccines, West Point, Pa., said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The visits recorded for this study took place between January 2013 and June 2013, and involved girls aged 11-12 years and boys aged 11-18 years. Physician participants were members of a panel for a dialogue research company. While the physicians knew their interactions were being recorded, they were not aware that HPV vaccination approach was being evaluated.

The vaccination recommendation–style categories were based on an analysis of the visit recordings. The “routine recommendation” style involved a matter-of-fact recommendation made the same way recommendations for other adolescent vaccines were made. The “brief mention” style involved mention of the vaccine without a recommendation or direction. And the “detailed discussion” style involved a discussion with a parent in greater detail than was provided for other adolescent vaccines.

The findings of this study – the first qualitative project to assess how physicians discuss and recommend HPV vaccination to patients and caregivers – are important, because HPV vaccination rates in the United States remain relatively low, Dr. Clark explained.

Of note, physicians report significant parental barriers to acceptance of routine HPV vaccine recommendations, but parents report a high likelihood of accepting the recommendations of the provider, she added.

Evaluation of the dialogue between physicians and patients in this study suggests that physician recommendations to patients are not consistent with vaccination recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, Dr. Clark said, and many physicians are uncomfortable discussing HPV vaccination.

In addition, some physicians recommended vaccination at age 14-15 years and/or tied vaccination recommendations to sexual activity, rather than recommending vaccination at age 11-12 years. Many physicians also left the decision up to the caregiver and failed to make a strong recommendation, Dr. Clark said. Furthermore, many physicians told patients and parents that vaccination did not need to happen that day, allowing for a missed vaccination opportunity.

Though limited by the small pediatrician sample size and the fact that the participating physicians were part of a paid panel and thus may not be representative of the broader pediatric community, the findings suggest that pediatricians may benefit from training to improve their HPV vaccination recommendations, Dr. Clark said.

Dr. Clark is an employee of Merck Vaccines.

PHILADELPHIA– A “routine recommendation” approach was the most effective but least used strategy for promoting same-day human papillomavirus vaccination in adolescent boys and girls, according to an industry-funded study of more than 150 well-visit interactions.

Of 204 well visits with 20 pediatricians, 167 (82%) involved discussion of adolescent vaccination, and 152 (75%) specifically mentioned HPV vaccination.

Vaccine recommendation approaches used in the recorded visits were categorized into three styles: “routine recommendation,” which was used in 11% of visits, yielding a 94% same-day vaccination rate; “brief mention,” which was used in 17% of visits, yielding a 27% same-day vaccination rate; and “detailed discussion,” which was used in 72% of visits, yielding a 38% same-day vaccination rate, Dr. Liana R. Clark reported at an annual scientific meeting on infectious diseases.

More specifically, the routine recommendation approach was used during 15% of visits with 32 girls aged 11-12 years, 7% of visits with 42 boys aged 11-12 years, and 10% of visits with 78 boys aged 13-18 years, yielding same-day vaccination rates of 80%, 100%, and 100%, respectively.

The brief intervention approach was used in 19%, 29%, and 13% of the visits, yielding same-day vaccination rates of 17%, 8%, and 20%, respectively. And the detailed discussion approach was used in 66%, 64%, and 77% of the visits, yielding same-day vaccination rates of 19%, 33%, and 47%, respectively, Dr. Clark of Merck Vaccines, West Point, Pa., said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The visits recorded for this study took place between January 2013 and June 2013, and involved girls aged 11-12 years and boys aged 11-18 years. Physician participants were members of a panel for a dialogue research company. While the physicians knew their interactions were being recorded, they were not aware that HPV vaccination approach was being evaluated.

The vaccination recommendation–style categories were based on an analysis of the visit recordings. The “routine recommendation” style involved a matter-of-fact recommendation made the same way recommendations for other adolescent vaccines were made. The “brief mention” style involved mention of the vaccine without a recommendation or direction. And the “detailed discussion” style involved a discussion with a parent in greater detail than was provided for other adolescent vaccines.

The findings of this study – the first qualitative project to assess how physicians discuss and recommend HPV vaccination to patients and caregivers – are important, because HPV vaccination rates in the United States remain relatively low, Dr. Clark explained.

Of note, physicians report significant parental barriers to acceptance of routine HPV vaccine recommendations, but parents report a high likelihood of accepting the recommendations of the provider, she added.

Evaluation of the dialogue between physicians and patients in this study suggests that physician recommendations to patients are not consistent with vaccination recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, Dr. Clark said, and many physicians are uncomfortable discussing HPV vaccination.

In addition, some physicians recommended vaccination at age 14-15 years and/or tied vaccination recommendations to sexual activity, rather than recommending vaccination at age 11-12 years. Many physicians also left the decision up to the caregiver and failed to make a strong recommendation, Dr. Clark said. Furthermore, many physicians told patients and parents that vaccination did not need to happen that day, allowing for a missed vaccination opportunity.

Though limited by the small pediatrician sample size and the fact that the participating physicians were part of a paid panel and thus may not be representative of the broader pediatric community, the findings suggest that pediatricians may benefit from training to improve their HPV vaccination recommendations, Dr. Clark said.

Dr. Clark is an employee of Merck Vaccines.

PHILADELPHIA– A “routine recommendation” approach was the most effective but least used strategy for promoting same-day human papillomavirus vaccination in adolescent boys and girls, according to an industry-funded study of more than 150 well-visit interactions.

Of 204 well visits with 20 pediatricians, 167 (82%) involved discussion of adolescent vaccination, and 152 (75%) specifically mentioned HPV vaccination.

Vaccine recommendation approaches used in the recorded visits were categorized into three styles: “routine recommendation,” which was used in 11% of visits, yielding a 94% same-day vaccination rate; “brief mention,” which was used in 17% of visits, yielding a 27% same-day vaccination rate; and “detailed discussion,” which was used in 72% of visits, yielding a 38% same-day vaccination rate, Dr. Liana R. Clark reported at an annual scientific meeting on infectious diseases.

More specifically, the routine recommendation approach was used during 15% of visits with 32 girls aged 11-12 years, 7% of visits with 42 boys aged 11-12 years, and 10% of visits with 78 boys aged 13-18 years, yielding same-day vaccination rates of 80%, 100%, and 100%, respectively.

The brief intervention approach was used in 19%, 29%, and 13% of the visits, yielding same-day vaccination rates of 17%, 8%, and 20%, respectively. And the detailed discussion approach was used in 66%, 64%, and 77% of the visits, yielding same-day vaccination rates of 19%, 33%, and 47%, respectively, Dr. Clark of Merck Vaccines, West Point, Pa., said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The visits recorded for this study took place between January 2013 and June 2013, and involved girls aged 11-12 years and boys aged 11-18 years. Physician participants were members of a panel for a dialogue research company. While the physicians knew their interactions were being recorded, they were not aware that HPV vaccination approach was being evaluated.

The vaccination recommendation–style categories were based on an analysis of the visit recordings. The “routine recommendation” style involved a matter-of-fact recommendation made the same way recommendations for other adolescent vaccines were made. The “brief mention” style involved mention of the vaccine without a recommendation or direction. And the “detailed discussion” style involved a discussion with a parent in greater detail than was provided for other adolescent vaccines.

The findings of this study – the first qualitative project to assess how physicians discuss and recommend HPV vaccination to patients and caregivers – are important, because HPV vaccination rates in the United States remain relatively low, Dr. Clark explained.

Of note, physicians report significant parental barriers to acceptance of routine HPV vaccine recommendations, but parents report a high likelihood of accepting the recommendations of the provider, she added.

Evaluation of the dialogue between physicians and patients in this study suggests that physician recommendations to patients are not consistent with vaccination recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, Dr. Clark said, and many physicians are uncomfortable discussing HPV vaccination.

In addition, some physicians recommended vaccination at age 14-15 years and/or tied vaccination recommendations to sexual activity, rather than recommending vaccination at age 11-12 years. Many physicians also left the decision up to the caregiver and failed to make a strong recommendation, Dr. Clark said. Furthermore, many physicians told patients and parents that vaccination did not need to happen that day, allowing for a missed vaccination opportunity.

Though limited by the small pediatrician sample size and the fact that the participating physicians were part of a paid panel and thus may not be representative of the broader pediatric community, the findings suggest that pediatricians may benefit from training to improve their HPV vaccination recommendations, Dr. Clark said.

Dr. Clark is an employee of Merck Vaccines.