Tuesday, March 18, 2008

Practical Considerations for Delivery of Human Papillomavirus Vaccine: Pediatrician Perspectives

Cynthia M. Rand1, Stanley J. Schaffer2, Sharon G. Humiston1, Laura P. Shone2, Christina Albertin2, Aaron K. Blumkin2, and Peter G. Szilagyi2. (1) Univ. of Rochester, Strong Memorial Hospital, 601 Elmwood Ave, Rochester, NY, USA, (2) Department of Pediatrics, University of Rochester, 601 Elmwood Ave, Box 777, Rochester, NY, USA

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to understand pediatrician's perspectives about practical issues related to human papillomavirus (HPV) vaccine delivery.

HPV vaccine was recently recommended for adolescent females, yet it is unclear how pediatricians plan to deliver 3 vaccinations in a short time period.

Assess (1) pediatricians' perception of feasibility of delivering 3 HPV vaccine doses to adolescent patients within 1 year vs. annually for 3 years, (2) methods used for recall for subsequent vaccinations, and (3) types of visits at which HPV vaccine would be delivered.

47-item mailed survey of 806 pediatricians in the US, with names obtained from the AMA Master File and addresses confirmed by phone. Three rounds of surveys were mailed. Frequencies and chi-square tests were performed.

Response rate was 47% (n=379). 55% of pediatricians felt it would be somewhat or very difficult to deliver 3 doses within 1 year, 42% felt annual vaccinations would be somewhat or very difficult (p<0.01). Pediatricians planned to use the following methods for reminders for subsequent HPV vaccinations: 41% staff phone calls, 27% mailed postcard/letter, 8% autodialer, 1% e-mail, 29% no method.
Initial vaccinations were planned at check-ups (96%) more than at acute (22%, p< 0.01) and chronic illness visits (43%, p<0.01). Subsequent immunizations were most likely to be delivered at immunization-only visits (86%) and least likely to be administered at acute illness visits (39%).

More than half of pediatricians expect some difficulty in administering 3 HPV vaccines to adolescents, and annual vaccination remains difficult for many. Phone calls are the most likely method to remind adolescents about subsequent vaccinations, although almost 1/3 plan to do nothing. While pediatricians are less likely to provide HPV vaccination at illness visits, doing so may be needed to reach all adolescents with 3 vaccinations.