Efforts to Increase HPV Vaccination

Transcription

1 Efforts to Increase HPV Vaccination Pamela Hull, Ph.D. Assistant Professor of Medicine Department of Medicine, Division of Epidemiology Vanderbilt University Medical Center Tennessee Cancer Consortium Conference 20 July 2017 Meharry-Vanderbilt-TSU Cancer Partnership

2 Key Challenges Lack of effective provider recommendation Treat HPV vaccine as different Less emphasis on vaccinating boys Delay recommendation until teens are older Missed clinical opportunities Lack of patient reminders Gaps in parental knowledge

3 Social Marketing: Audience Research Parents: Split Undecided market segment into: Ready If Offered Easily accept vaccine if given opportunity Need basic info and provider recommendation Skeptical Need in-depth info about safety concerns Question why vaccinate at early age Question link with sexual activity Some mistrust of drug companies

4 Social Marketing: Audience Research Normalize perception of HPV vaccine as routine Boys and girls Together with other pre-teen vaccines Emphasize cancer prevention over STD Tailor for pre-teen versus teen audiences Parents are key decision-makers (esp. pre-teens) Completion of multi-dose series Ineffective communication at doctor s office Return appointments and reminders

5 Patient Education using Social Marketing Developed educational materials targeting parents Community engagement Culturally-appropriate Website/video: get3shots.org Tested in workshop format 71 racially/ethnically-diverse parents Delayed crossover design Funding: MMC-VICC-TSU Cancer Partnership (U54CA163072); Pilot , Admin Supplement

6 Education Increased HPV Vaccine Uptake 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 60.0% 90.3% p<.05 Plan to Talk to Doctor (Post Workshop) 4.5% Control Intervention 33.3% p<.05 HPV Vaccine Receipt at 2-4 mo. Follow Up Study Sample: 55 Families with follow up data; 27% White, 32% Black, 35% Hispanic

7 Pilot Quality Improvement Project University-based general pediatrics practice Goals: a) Bundle adolescent vaccines during year old well visits b) Increase uptake of HPV vaccine

8 QI Objectives 1. Provider Level: Change timing and strength of recommendations (same day, same way) Previous: Tdap/MCV4 at 11, HPV at 12+ New: Bundle starting at Practice Level: Incorporate patient education materials in well visits Prompt parents to sign up for appointments/reminders

9 Practice: Workflow Changes Using Bug Your Doc Get 3 Shots! Materials 1 week before well visit: Appointment reminder call: Check in: Exam room: Giving shot: Mail educational brochure Remind parent to read mailer Give flyer & magnet After intake, nurse asks parent to watch video & browse website Nurse gives parent sheet with return dates Check out: Make appointment for follow up dose(s)

10 Bundling Adolescent Vaccines 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 2014 (Pre-Intervention, N=47) 2015 (Post-Intervention, N=74) 81.8% 69.2% 66.2% 62.9% 59.6% 10.0% 4.3% 3.3% 5.9% 0.0% Overall Females Males Age 11 Age 12 All pre-post differences significant at p<.001 Bundling = Tdap+MCV4+HPV vaccines given in same visit (if due for all 3)

11 HPV Vaccine: Next Dose Due 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 2014 (Pre-Intervention, N=66) 2015 (Post-Intervention, N=105) 72.2% 73.6% 66.7% 60.8% 59.6% 27.3% 16.7% 15.2% 18.2% 6.1% Overall Females Males Age 11 Age 12 All pre-post differences significant at p<.001 One child in each year had already received HPV vaccine

12 Bug Your Doc Materials Outside & inside of Clinic Mailer Front & Back of Clinic Flyer (space for logo) Magnet Bug Your Doc Get 3 Shots! website

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15 How to increase the number of target patients who come in & leave vaccinated 1. Know your coverage rates Clinic-level rates are great, but rates for individual clinicians are even better! Rates can come from: Data from EHR State immunization registry (TennIIS)

16 How to increase the number of target patients who come in & leave vaccinated 2. Align office/clinic policy with mission Immunize at every opportunity Implement and utilize standing orders Prompt the person ordering the vaccine in multiple ways Reminders & Recalls

17 How to increase the number of target patients who come in & leave vaccinated 3. Align communication with mission Give staff a cancer-prevention mission All staff need to be saying the same thing Share talking points Use the Tip Sheet Hold an in-service

18 Collaborators Meharry Medical College Maureen Sanderson, PhD Juan Canedo, DHSc Vanderbilt University Debra Friedman, MD Caree McAfee, MA, CHES Candace Dean, BA Dineo Khabele, MD Todd Lawrence, MA Tennessee State University Elizabeth Williams, PhD Cumberland Pediatric Foundation Lora Harnack, MSN Janet Cates, BA Community Partners MVTCP Community Advisory Board Progreso Community Center University-based pediatrics practice Cervical Cancer Free Tennessee TN Department of Health Meharry-Vanderbilt-TSU Cancer Partnership Supported by NIH grant numbers: U54CA163072, U54CA163066, U54CA163069, 3P30CA S3, UL1 RR024975, UL1 TR Cervical Cancer Free Tennessee Coalition

19 Resources & Partners Centers for Disease Control & Prevention (CDC): American Academy of Pediatrics (AAP): Cervical Cancer Free Tennessee (CCFTN): Cumberland Pediatric Foundation (CPF): TN Chapter-AAP: Pediatric Healthcare Improvement Initiative for Tennessee (PHiiT)