Abigail Breck, Mary Kate Kelly, Margaret Wright, Alisa J. Stephens-Shields, Russell Localio, Robert W. Grundmeier, Christina Albertin, Laura P Shone, Jennifer Steffes, Sharon G. Humiston, Cynthia Rand, Dianna E. Abney, Alexander Fiks, Peter G. Szilagyi
Presented at the 2019 Pediatric Academic Societies Annual Meeting.
Background: HPV vaccination rates remain low, leaving many youth susceptible to HPV-disease. HPV missed opportunities (MOs) are visits with a provider during which a patient was eligible for HPV vaccine but did not receive it. While some national information is known about simultaneous MOs (when HPV-vaccine eligible patients receive another vaccine but not HPV), little is known nationally about MOs overall for HPV vaccine.
Objective: To describe, in a national sample of pediatric primary care practices: (a) the prevalence of MOs, (b) patient and visit features associated with MOs, and (c) the proportion of overall MOs that involve simultaneous MOs.
Design/Methods: As part of the NIH-funded STOP-HPV trial, we extracted electronic health record data from 23 practices across 10 states recruited from the AAP Pediatric Research in Office Settings national pediatric primary care network. We extracted all office visits (excluding nurse-only visits) from 2015-2018 among HPV vaccine-eligible 11-17-year olds. Using descriptive analyses, we examined MOs (overall and simultaneous), and by visit type (preventive, acute/chronic), patient sex and age, and HPV dose due (initial or subsequent).
Results: 58,043 adolescents had 173,199 visits at which HPV vaccine was due [Table 1]. In 82% of visits where the first HPV vaccine dose was due there was a MO. This occurred in 61% of HPV-vaccine eligible preventive visits and 98% of HPV-vaccine eligible acute/chronic visits. MOs during visits at which the subsequent HPV vaccine dose was due were not as high: 58% of all such eligible visits, including 15% of preventive visits and 84% of acute/chronic visits. Across both initial and subsequent HPV-vaccine eligible visits, MOs were higher at visits for 13-17yr olds than at visits for 11-12yr olds (e.g., for 1st doses—85% vs 79%). Simultaneous MOs accounted for only a minority (14%) of all MOs overall, at preventive or acute/chronic visits, and among both younger and older adolescents [Table 2; Figure 1, calculations from results in Tables 1 and 2].
Conclusion: MOs for HPV vaccine are high, even during visits with patients who accepted a previous HPV vaccine dose. Few adolescents are vaccinated during acute/chronic visits, even for subsequent HPV doses. Higher MOs among older adolescents may be a function of vaccine refusal. Simultaneous MOs represent only a minority of all MOs. Strategies to reduce HPV MOs are needed.
