JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
METHODS
The sample consisted of providers whose patient populations were entirely or partially children, ages 0–18. Six providers had a patient population of 100% children. The remaining providers had patient populations of at least 85% children. The majority (79%) of the patient populations of the participating providers had family incomes below 200% of the federal poverty level. Themes identified through the analysis are shown in Table 1. The interviews showed that high-performing providers used a variety of strategies to get parents and youth/adolescents to initiate and complete the three-dose HPV vaccine series: education, standing orders, reminders, and scheduling vaccine appointments during current appointment. Other successful strategies included coupling the HPV vaccine with adolescent vaccines, administering during well visits, recommending the vaccine, and indicating that the HPV vaccine protects against cancer (Figure 1). These researchers discovered that examining shot records helped providers stay abreast of patients that were eligible for the vaccine. As a result, patients and parents were able to receive education about the vaccine or the vaccine itself at well child visits or other doctor appointments. The most frequently used strategies (Figure 1) were education (n=11) and standing orders (n=11), followed by reminders (n=10) and scheduling appointments for doses two and three during the current visit (n=8). Other strategies that were used moderately often include: offering the HPV vaccine with the other adolescent vaccines (n=6), indicating that the vaccine can protect against cancer (n=6), recommending the vaccine to patients (n=6), and offering the vaccine during well visits (n=6). The least frequent strategy reported by providers was informing parents that their insurance may cover the cost of the vaccine, thereby removing cost as a barrier (n=1) and only two providers indicated discussing the association of HPV infection with sexual activity. Specific provider comments regarding strategies to increase HPV vaccination rates are detailed in Table 2.
This study sought to identify uncommon but successful behaviors that lead to better outcomes in HPV vaccination. The purpose was to identify best practices used by top performers. This qualitative study was conducted by the Louisiana Cancer Prevention and Control Program (LCP) with assistance from the Louisiana Department of Health Office of Public Health Immunization Office. The Immunization Office identified providers with above average HPV vaccination rates based on total volumeof vaccineadministeredcompared toall providers in Louisiana. The volume of vaccine administered was determined by utilization of the immunization information system, Louisiana Immunization Network for Kids Statewide (LINKS), for inventory management. Three high-volume providers were identified in each of the nine public health regions in the state. Additional inclusion criteria were: 1) the key informant had to be 18 years or older, 2) be a healthcare provider or clinic director/administrator, and 3) providers must participate in Louisiana’s childhood immunization program and be English speaking. As a result, 28 providers were identified as having above average vaccine uptake. Of the 28 providers, 25 were pediatric clinics. The three remaining clinics offered services across age ranges. This study was approved by the Institutional Review Board. The selected providers were contacted via letter from the Louisiana Immunization Office to explain the study and were asked if they agreed to be contacted by LCP. Contact information was then given to LCP to conduct key informant interviews. Structured interviews were conducted with a representative from each of the twelve providers who participated in the study. The interviews were conducted using an interview guide developedby LCP toexplore strategiesproviders used to increase HPV vaccine uptake. The interview guide included questions to elicit information on provider demographics and strategies used to increase HPV vaccination. General topics assessed were provider policies and procedures, provider-parent interaction, and provider strategies to increase HPV vaccination. Interviews were conducted over the phone and recorded with participant permission. Statistical Analysis Interviews were recorded for transcription and analyzed using NVivo11 qualitative analysis software. Interviews were linked with providers’ demographic data in NVivo. Each interview was independently coded. This was an iterative process. After completion of the independent coding, the authors came together to reviews the codes and identify common themes (Table 1). Differences were resolved through consensus.
Strategies Used by Providers to Increase Vaccination Rates
92%
92%
83%
12
75%
10
8
50% 50% 50%
50%
6
33%
25%
RESULTS
4
17%
8%
2
Twelve of the 28 providers agreed to participate in the study. The 16 providers that did not participate either did not return calls to schedule an interview, chose not to participate, or a representative was not able to answer interview questions. The participants came from seven of the nine public health regions of the state and seven of the 64 parishes in the state.
0
Theme
Figure 1. Strategies used by providers to increase vaccination rates
64 J La State Med Soc VOL 169 MAY/JUNE 2017
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