Improving HPV vaccine delivery at school-based health centers. Issue 7 (3rd August 2019)

• Record Type: Journal Article
• Authors: Oliver, Kristin; McCorkell, Colleen; Pister, Ilana; Majid, Noora; Benkel, Denise H.; Zucker, Jane R.
• Is Part Of: Human vaccines & immunotherapeutics. Volume 15:Issue 7/8(2019)
• Page Start: 1870
• Page End: 1877
• Publication Date: 2019-08-03
• Subjects: Human papillomavirus vaccination (HPV) -- school-based health -- quality improvement; Vaccines -- Periodicals; 615.372
• DOI: 10.1080/21645515.2019.1578596
• Languages: English
• ISSNs: 2164-5515

Abstract

ABSTRACT: Objective: To identify characteristics associated with human papillomavirus (HPV) vaccination rates, describe barriers and facilitators to vaccine uptake and the potential role for clinician-to-clinician Assessment, Feedback, Incentives, and eXchange (AFIX) visits in school-based health centers (SBHCs). Methods : We conducted clinician-to-clinician AFIX visits at 24 New York City (NYC) high-school and middle-school SBHCs with up-to-date adolescent vaccination rates below 40%. Using NYC's immunization information system, we assessed HPV initiation and series completion rates at the time of AFIX visit and follow-up three to five months later. We analyzed responses to a questionnaire and summarized interviews to identify barriers and facilitators to HPV immunization practices and quality improvement (QI) implementation. Results : Baseline initiation and completion rates were 76% and 43% for high schools, and 81% and 45% for middle schools. SBHCs that allowed adolescent self-consent or did not require separate vaccine consent had higher baseline rates, but was not statistically significant. Barriers to series completion included challenges with scheduling and appointment compliance. At follow-up, high school SBHCs increased HPV vaccine initiation by 2.9 percentage points (p < 0.01) and series completion by 2.7 percentage points (p < 0.05). There was no statistically significant increase at middle school SBHCs. Most SBHCs (88%) chose reminder/recall systems as a QI strategy. Fewer than half (42%) implemented their QI strategy. Conclusions : We identified barriers to HPV vaccine series completion at our sample of SBHCs. Clinician-to-clinician AFIX visits may help improve vaccination rates and encourage providers to address barriers, including streamlining consent processes for HPV vaccination. Abbreviations : School-based health (SBH); quality improvement (QI)