Reminder Stamp Boosts HPV Vaccination

Rubber stamping a patient’s chart with a reminder about the human papillomavirus (HPV) vaccine was associated with a greater than four-fold increase in vaccination rates at one institution.

At the start of the study, the charts of eligible patients in the outpatient gynecological setting indicated that 11% were following through with the HPV vaccination, but after the reminder stamp was added to the charts, the vaccination rate increased to 49% (P<0.0001), said Kerry Rut, DO, of Winthrop University Hospital, Mineola, N.Y., and colleagues.

“We were aiming to at least get our institution at the national level or 25%, but were really able to greatly exceed that,” Rut told MedPage Today at her poster presentation during the annual clinical meeting of the American College of Obstetricians and Gynecologists. “We think that the reminder was the main factor in getting more compliance with the vaccine.”

The authors began by determining the baseline vaccination rate at their outpatient office from March to May of 2010. They created a “Gardasil Vaccination Reminder” stamp and progress notes were stamped from June 2010 to December 2010. Charts were assessed to establish a vaccination rate with the stamp.

They found that vaccination rates after introduction of the reminder stamp (49%) were significantly better than baseline (11%) for an odds ratio of 4.64 (P<0.0001). They also reported that documentation of a discussion about the vaccine between patient and healthcare provider was evident in 90% of the stamped charts compared with only 22% of the charts without the stamp (P<0.0001). Logistic regression demonstrated that age, type of insurance, reason for visit, and history of abnormal PAP smears were not independently associated with vaccination. The only independent variable was use of the stamp, the authors stated. But the stamp could not overcome all barriers to HPV vaccination. Rut reported that 54% of the women or girls refused the vaccine, even after counseling. "We were told numerous times that the girls who refused had seen a YouTube video purportedly showing a girl disabled by the vaccine. We have no way of knowing if the film clip is genuine, but we know it is keeping many of our patients from getting the vaccination," she said. However, Rut also noted that the stamp improved the performance of the healthcare professionals in terms of vaccine delivery. At baseline, one provider had successfully vaccinated 33% of her patients, but boosted that number to 79% with the presence of the red reminder stamp on the charts (P=0.04). The fact that the HPV vaccine is relatively new may be one reason that patients shy away from it, commented Dan Kiefer, MD, from Lehigh Valley Health Network in Allentown, Pa. "I think there is an apprehension among people about vaccines, especially newer ones," Kiefer told MedPage Today. "They don't want to be the first to get one, and then find out 20 years later that there is a problem. I think that is what is going on." The authors said an evaluation of counseling practices, and reasons for patient refusal would help to further increase vaccination rates. A recent study in Pediatrics found that mandatory vaccination for entry to middle school appeared to increase HPV vaccine coverage among students.

The study authors disclosed no conflicts of interest. Kiefer had no conflicts of interest.
Primary source: American College of Obstetricians and Gynecologists Source reference: Rut K, et al “Improving Gardasil vaccination rates” ACOG 2012.

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