GP communication intervention may bolster adolescent HPV vaccination rates
A five-component communication training intervention for primary care physicians appears to improve human papillomavirus (HPV) vaccination rates in adolescents, a recent study found.
Researchers recruited 188 healthcare professionals from 16 primary care practices (12 paediatric and four family medicine) in Denver, Colorado, US, and randomized them 1:1 to participate in the HPV vaccine communication intervention or serve as a control group (providing usual care).
The intervention consisted of five components ie, a parent education website, a series of images of HPV-related disease, an HPV vaccine decision aid, an HPV fact sheet library, and 2 and ½ hours of communication training on vaccine recommendations which included motivational training to use when dealing with resistant parents. Healthcare professionals at each practice were required to attend two intervention development meetings within 6 months prior to initiating the intervention.
The effect of the intervention vs control was assessed in 43,132 adolescent patients aged 11–17 years (median age 12.6 years, 50.3 percent female, 54.9 percent Caucasian) who attended the primary care practices.
Adolescent patients who attended the intervention practices were more likely to initiate HPV vaccination compared with those who attended the non-intervention practices (adjusted odds ratio [adjOR], 1.46, 95 percent confidence interval [CI], 1.31–1.62, absolute percentage point increase, 9.5; p<0.001). [JAMA Pediatr 2018;doi:10.1001/jamapediatrics.2018.0016]
Patients who attended the intervention practices were also more likely to complete the HPV vaccination series compared with those who attended the non-intervention practices (adjOR, 1.56, 95 percent CI, 1.27–1.92). Conversely, HPV series completion decreased in non-intervention practices.
The results also indicated a reduction in the number of missed opportunities for vaccination in the intervention compared with the control practices at well-child care visits (adjOR, 0.61).
Healthcare professionals in the intervention group found the communication techniques and fact sheets to be the most frequently used components of the intervention, with 72.2–90.0 percent using communication training and 51.5–84.4 percent using the fact sheets. Furthermore, an end-of-study survey showed that 98 and 91 percent of healthcare professionals were keen to continue using the fact sheets and communication techniques, respectively.
Due to the study design which required healthcare professionals to provide quarterly reports on components used during the previous month and not on a patient-to-patient basis, the effect of specific components of the intervention on an individual patient level could not be established. As such, the researchers recommended further study into assessing the need for the other components.
“A key factor influencing adolescent HPV vaccination is whether and how a healthcare professional recommends it. Numerous studies demonstrate that medical professionals often fail to communicate effectively about the vaccine with patients and parents,” said the researchers. [Cancer Epidemiol Biomarkers Prev 2016;25:1435-1446; Am J Prev Med 2014;46:80-84; Cancer Epidemiol Biomarkers Prev 2015;24:1673-1679]
“[Results of this study showed that] a five-component intervention significantly increased HPV vaccine series initiation, stopped decline of completion, and was effective for both boys and girls. Disseminating this intervention widely among primary care professionals could substantially increase national adolescent HPV vaccination levels,” they said.