JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Louisiana Physicians Are Increasing HPV Vaccination Rates
Donna Lisa Williams, DrPH, Courtney Suzanne Wheeler, MPH, Michelle Lawrence, MPH Stacy Stevens Hall, RN MSN, Michael Hagensee, MD
Human papilloma virus (HPV) is a common virus that can cause genital warts and certain cancers. The HPV vaccine is effective in preventing many HPV-associated diseases, however, vaccinationrates suggestmanyremainunprotected. This study examined successful strategies usedby physicians to improve HPV vaccination rates. Providers with above average vaccination rates were identified. A representative from each provider participated in an interview to identify strategies used to boost HPV vaccination. Keystrategies inensuringvaccinecompletionwerereminders, education, standing orders, and scheduling future vaccine appointments at timeof first dose. Other successful strategies included coupling theHPV vaccinewith adolescent vaccines, administering during well-visits, and recommending the vaccine as protection against cancer and genital warts. Findings suggest successful andwidelyusedmethods among highperformingproviders inLouisiana, themajorityofwhich should be easily reproducible with minimal resources to improve HPV vaccination rates.
insurance marketplace, most small and large group plans, and most employer self-insured plans. While some plans existing before 2010 were grandfathered in and not required to provide the preventive services with no cost-sharing, the percentage of plans falling into this category is decreasing, and, over time, most plans will lose this status. 5 Despite evidence that the vaccine is effective in reducing infection and its coverage by most insurances, rates remain below the Health People 2020 recommendation of 80%, 6,7 suggesting that many in the U.S. remain unprotected. The 2015 National Immunization Survey (NIS) results for completing all three shots in the HPV series for females was 39.3% and for males was 30.5% in Louisiana, 7 both of which are significantly lower than the Healthy People 2020 target of 80% vaccination coverage. In October 2016, the Centers for Disease Control and Prevention changed its recommendations to a two shot series for adolescents under 15. 8 While this should ease some of the barriers associated with series completion, with only 60.3% of females and 49.5% of males initiating the series in Louisiana in 2015, there is still a great deal of room for improvement. 9 Previous research examined various methods used to increase vaccine uptake. 10-14 These strategies range from educating both the providers and parents/adolescents to system changes, such as implementing standing orders or a reminder recall system. The study by Cassidy et al. supports the benefit of provider recommendation; 78.3% of parents mentioned that a recommendation from the providers aided in their decision to vaccinate. This study, as well as others, illustrate the benefit of patient reminders. 10-14 Other studies have found that shot records helped to improve vaccination rates. 11,14 In examining vaccination providers in Louisiana, it was obvious that some providers were having better HPV vaccination outcomes compared to other providers in the state (unpublished data). So what strategies are pediatricians and other healthcare providers in Louisiana using to increase the HPV vaccination rate and how can these strategies be used in any practice? The intent of this study was to discover uncommon but successful strategies providers can implement in their practices at little to no cost to increase initiation and completion of the vaccine series.
INTRODUCTION
Human papillomavirus (HPV) is a common virus that has been shown to cause genital warts, as well as anogenital and oropharyngeal cancers. 1 In fact, HPV is estimated to cause close to 27,000 cancers each year in the U.S. 1 and an average of 1,429 cancers annually in Louisiana. 2,3 Most cervical cancers are caused by HPV, but so are a majority of the cancers of the vagina, vulva, penis, anus, and throat. The first HPV vaccine was approved by the Food and Drug Administration over a decade ago, and the various iterations of the vaccine have been shown to be effective in preventing cervical cancer and other HPV-associated cancers and genital warts. Vaccines are available for males and females ages 9–26, however, the federal Advisory Committee on Immunization Practices (ACIP) has recommended routine vaccination for male and female adolescents ages 11–12. 4 Under the Affordable Care Act, most health plans must cover a defined set of preventive services with no cost-sharing by the patient, including HPV vaccination for children from age 11- 21. The included health plans are Medicaid, the plans in the
J La State Med Soc VOL 169 MAY/JUNE 2017 63
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