Editor’s Note: Elizabeth Zeichner (she/her) is a former high school teacher and a resident physician in pediatrics at the Children’s Hospital of Philadelphia. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
The American Academy of Pediatrics (AAP) recommends routine human papillomavirus (HPV) vaccination for all adolescents starting between age 9 and 12 years. The HPV vaccine has been proven to be highly effective in preventing HPV-related cancers. Though we discuss vaccination at all our well-child visits, in 2021, only 77% of US adolescents ages 13-17 years had initiated and 62% had completed the vaccination series.
This week, Pediatrics is early releasing an article and accompanying video abstract entitled “A Bundled, Practice-Based Intervention to Increase HPV Vaccination” (10.1542/peds.2024-068145). Authors Peter Szilagyi, MD, Alexander Fiks, MD, and colleagues from the University of California Los Angeles, Children’s Hospital of Philadelphia, and other institutions in the AAP’s Pediatric Research in Office Settings (PROS) network created a multi-component intervention to implement during well-child visits in efforts to improve HPV vaccination and decrease missed HPV vaccination opportunities.
Their bundled intervention was comprised of three components:
- Training for clinicians on communicating with patients and families about the HPV vaccine
- Performance feedback for clinicians on HPV vaccination opportunities in eligible visits
- Prompts (e.g., within electronic medical record systems) for clinicians to address HPV vaccination in visits
Of the 24 practices recruited to participate in this bundled intervention, 22 practices completed the intervention over a 6-month period. The primary outcome was the missed opportunity rate for an HPV vaccine—in other words, when a patient was eligible for, but did not receive the HPV vaccine during the visit.
The authors found this multi-component intervention improved missed opportunity rates for HPV vaccination by 4.8% for the initial HPV vaccination and 2.2% for subsequent vaccinations. Interestingly, the 3 interventions that made up this bundled intervention were also implemented as separate interventions in prior randomized controlled trials during the same timeframe, and there was more improvement in missed opportunity rates in the bundled intervention than in each comparison practice, emphasizing the value of a multi-part intervention.
Notably, communication training was the most effective intervention in adolescent HPV vaccination, underscoring the importance of open communication with families.
As there are many factors—from patient/family values to system-wide structures (such as ways in which vaccines are discussed and offered)—that contribute to ultimately receiving a vaccine, this bundled intervention adds helpful insight on ways to increase uptake of this highly effective vaccine among our adolescent patients.
