Human Papillomavirus Vaccination Practices: a National Survey of Physicians 18 Months Post-Licensure

Background:
Little is known about physician vaccination practices following licensure of a human papillomavirus (HPV) vaccine.

Objectives:
To assess, in a nationally representative sample of family medicine (FM) and pediatric (Ped) physicians: 1) HPV vaccination practices; 2) perceived barriers to vaccination; and 3) factors associated with not strongly recommending HPV vaccine to 11-12-year-old female patients.

Methods:
During January-March 2008, a survey was administered to a sentinel network of 419 FM and 431 Ped physicians.

Results:
Response rates were 79% for FM and 81% for Ped. Eighty-eight percent of FM and 98% of Ped were giving HPV vaccine in their office (p<0.001). Among physicians giving HPV vaccine, fewer strongly recommended it for 11-12-year-old than for 13-15-year-old females (FM, 50% for 11-12 y.o. vs. 85% for 13-15 y.o., p<0.001; Ped, 56% vs. 90%, respectively, p<0.001). For both specialties, the most frequently reported barriers to HPV vaccination were financial, including vaccine costs, reimbursement, and insurance coverage. In multivariate analyses, factors associated with not strongly recommending HPV vaccine to 11-12-year-old females included: considering it necessary to discuss sexuality prior to recommending HPV vaccine (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.1-2.4), reporting more vaccine refusal among parents of younger vs. older adolescents (OR 4.0, CI 2.5-6.4), and believing the time needed to discuss HPV vaccination was definitely/somewhat a barrier (OR 1.9, CI 1.1-3.4).

Conclusions:
HPV vaccine appears to have been widely adopted into FM and Ped practices nationally, but was recommended less strongly to 11-12-year-old than to older patients. Financial concerns about HPV vaccine were common. Missed vaccination opportunities in younger adolescents and financial barriers may have important implications for HPV vaccine coverage.