Provider and Practice Factors Associated With On-Time HPV Vaccination in Primary Care

• Published in: Academic pediatrics Vol. 23; no. 4; pp. 800 - 807
• Main Authors: Garbutt, Jane, Wang, Ruoyun, Graham, Sharon, McKay, Virginia, Haire-Joshu, Debra, Barker, Abigail, Liu, Lei
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023
• Subjects: Child; Female; Health Knowledge, Attitudes, Practice; human papillomavirus vaccine; Humans; Male; Neonatal and Perinatal Medicine; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - therapeutic use; Parents; Pediatrics; primary care; Primary Health Care; Vaccination; human papillomavirus vaccine; primary care
• ISSN: 1876-2859; 1876-2867; 1876-2867
• DOI: 10.1016/j.acap.2022.12.015

In 2018, only one third of girls and boys completed the 2-dose series of the human papillomavirus vaccine by their 13th birthday, the target for on-time vaccination. The study objective was to identify key patient, provider and practice-level factors associated with on-time vaccination in the primary care setting. We examined data from 20 primary care pediatric practices (89 providers) in St. Louis including: the percentage of eligible patients with on-time vaccination assessed from medical records; providers’ knowledge, attitudes and behaviors regarding on-time vaccination assessed with a survey; and practice-level strategies used to optimize vaccine delivery assessed with a 19-item vaccine delivery system score (VDSS). Factors that increased on-time vaccination were identified using logistic regression, controlling for clustering within providers. Completion of on-time vaccination occurred in 1347/3125 (43.10%) of patients (95% confidence interval [CI], 41.36%–44.86%) and varied among practices (7.39%–64.24%) and among providers (2.63%–82.50%). Independent predictors for higher completion of on-time vaccination included more frequent use by providers of the announcement style for vaccine recommendation (odds ratio [OR] 1.18, 95% CI, 1.04, 1.35), higher provider self-efficacy to deliver the vaccine according to guideline recommendations if parents were hesitant (OR 1.21, 95% CI, 1.05, 1.40), and higher VDSS (OR 1.20, 95% CI, 1.10, 1.31). Provider and practice-level factors were identified that may represent modifiable targets for improvement in on-time vaccine uptake. Future research is needed to test interventions built on these findings.