Research Activities, February 2014
Combined clinician- and family-focused interventions are most effective in increasing HPV vaccination rates
Despite proven health benefits, human papillomavirus (HPV) vaccination rates to prevent cervical cancer, routinely given to adolescent women, are among the lowest of all routine immunizations. A new study on the effectiveness of targeting automated decision support to families and/or clinicians found that a combined clinician- and family-focused decision support intervention was most effective in improving vaccination rates and shortening the time to vaccine receipt for HPV doses 1, 2, and 3.
The clinician-focused intervention was more effective for HPV dose 1, while the family-focused intervention was more effective for HPV doses 2 and 3. The combined intervention increased the vaccination rate from 16 percent to 25 percent for dose 1, from 65 percent to 73 percent for dose 2, and from 63 percent to 76 percent for dose 3. The combined intervention significantly accelerated vaccination by 151, 68, and 93 days, respectively. The incremental costs per each additional girl vaccinated for the single most effective intervention (clinician-focused for HPV #1, family-focused for HPV #2 and #3) for each HPV dose were low, ranging from $6 to $10. All costs, including for the combined intervention, were substantially lower than for an immunization navigator program designed to bolster adolescent vaccination as well as preventive care, which cost $465 per additional adolescent fully vaccinated.
The study included 22 pediatric practices and 22,486 adolescent girls. The clinician decision support consisted of education (a 1-hour presentation either in person or online), electronic health record-based alerts, and audit and feedback. The family-focused decision support consisted of educational telephone calls. This study was supported by AHRQ (Contract No. 290-07-10013).
See "Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt," by Alexander G. Fiks, M.D., Robert W. Grundmeier, M.D., Stephanie Mayne, M.H.S., and others in Pediatrics 131, pp. 1114-1124, 2013.