Initiation of HPV Vaccination for Females: Does An Electronic Reminder System Influence Vaccination Coverage

Background: Human papillomavirus (HPV) is responsible for 5% of cancers worldwide.  In the US, it is the most common sexually transmitted infection. The HPV vaccine is recommended for females aged 11-12 years, and may be given to females aged 9-26 years for the prevention of cervical and anal cancers and pre-cancers. Unfortunately, the vaccine is under-utilized; only 14% of females in our practice receive the vaccine.

Objectives: To evaluate whether posting a reminder in the electronic health record will increase the rate of initiating the HPV vaccine series and identify factors related to vaccination.

Methods: The study sample included females 9-25 years of age without HPV vaccination. An electronic reminder stating the patient was eligible for vaccination was posted during a three month study period.  The primary outcome was the proportion of subjects starting the series, which was compared with the baseline proportion using a one sample binomial test. Independent variables included age (<18 or >18 years), provider type (faculty or resident), visit type (acute or wellness), and whether HPV vaccine was discussed during the visit. Fisher’s exact test was used to evaluate associations between these variables and HPV vaccination.

Results: Of 61 subjects, 8.2% initiated the HPV vaccine series (p=0.25 vs. 14%). Age and provider type were not significantly associated with vaccination (p=0.34 and p=0.07, respectively). However, visit type (wellness 30.8% vs. acute 2.1%) and discussing vaccination status (33.3% vs. 3.9%) were significantly related to initiating the series (p=0.006 and p=0.01, respectively).

Conclusions: In this study, an electronic reminder did not improve the initiation of HPV vaccination. Of note, vaccination was more likely at wellness than at acute visits. One strategy to improve coverage is to encourage providers to vaccinate at all visits. Also, addressing vaccination status with the patient at any type of visit may increase vaccination rates.