Effectiveness of a Targeted Program for HPV and Tdap Vaccination in the Community ObGyn Setting: Preliminary Results

Background: Obstetrician-gynecologists (ObGyns) are uniquely positioned to vaccinate women, particularly given recent guidelines on human papillomavirus (HPV) and tetanus-diphtheria-acellular pertussis (Tdap) vaccines.

Objectives: To implement a vaccination program for HPV and Tdap in community ObGyn offices.

Methods: A Vaccine Program for Women was implemented in 3 independent, moderate- to large-sized ObGyn offices in central North Carolina. Baseline vaccination rates were assessed in December 2008 via medical record review.  Program components included training and ongoing educational sessions about vaccine delivery with office staff and implementation of standing vaccination orders.  Screening and administration forms were designed as a 2-part carbonless form, allowing for clinical and research use via de-identified data collection.  Offices were instructed to provide screening forms to routine gynecology (Gyn) and postpartum (PP) patients.  Forms were utilized from July 2009 in Office A followed by Offices B and C in October 2009.  Only results for Office A are presented.

Results: Screening forms were completed by 473 Gyn and 35 PP patients from July – October 2009.  Mean age was 38 and 29 years for Gyn and PP patients, respectively.  Most patients were white race (83.4%) and privately insured (88.9%).  Using age ≤ 26 years for HPV vaccine eligibility, 111 Gyn and 16 PP patients were eligible for vaccine receipt.  HPV vaccination of Gyn patients increased marginally from 45.5% at baseline to 50.4%.  However, HPV vaccination of PP patients increased significantly from 0 to 47.1%.  Tdap vaccination rates dramatically increased for both Gyn (0 to 51.0%) and PP patients (16.7% to 85.7%).

Conclusions: Although this ObGyn office was offering HPV and Tdap vaccination, use of standing orders as well as screening and administration forms appears to greatly improve vaccine coverage for women.  Additional investigation is required to determine if specific patient or ObGyn-office characteristics affect vaccination practices and acceptance.