title: Additional health care visits needed among adolescents for human papillomavirus vaccine delivery within medical homes: a national study.
abstract: OBJECTIVE
  We estimated the additional number of primary care visits needed to deliver 3 doses of human papillomavirus vaccine to all US adolescents in medical homes. We determined adolescent and family factors associated with needing the greatest number of additional visits for full human papillomavirus vaccination.
  
  
  METHODS
  We performed a cross-sectional analysis of adolescents 11 to 21 years of age included in the 2002 and 2003 Medical Expenditure Panel Surveys (n = 2900) to measure existing primary care visits to pediatricians, family physicians, obstetrician/gynecologists, and internists. We then estimated additional visits needed for human papillomavirus vaccination. We determined the number of additional visits needed within a 6-, 12-, 18-, or 24-month vaccination window.
  
  
  RESULTS
  Within a 12-month period, 72% of female adolescents would need 3 visits for human papillomavirus vaccination if the vaccine was introduced at a preventive visit; 9% and 16% would need 1 and 2 more visits, respectively. Similarly, 79% of male patients would need 3 visits; 7% and 12% would need 1 and 2 more visits, respectively. If all opportunities to vaccinate were used, then 41% of female patients and 52% of male patients would need 3 additional visits within 12 months. With expansion of the window to 24 months and vaccination at every possible visit, 23% of female patients and 37% of male patients would need 3 additional visits. Factors that predicted needing more visits (2 or 3 vs 0 or 1 in 24 months) included being older, male, black, Hispanic, uninsured, and near-poor.
  
  
  CONCLUSIONS
  Most adolescents would require 2 or 3 additional primary care visits to receive 3 vaccines for human papillomavirus in the medical home. Strategies to minimize additional visits include vaccinating patients at all primary care visits and encouraging annual preventive visits.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. cynthia_rand@urmc.rochester.edu
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Rand
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: Christina
authors.initials: C
authors.lastname: Albertin
authors.forename: Peggy
authors.initials: P
authors.lastname: Auinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D020380:Needs Assessment; D009819:Office Visits / Q000706:statistics & numerical data*; D053918:Papillomavirus Vaccines; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups; D012737:Sex Factors; D014481:United States
chemical_list: D053918:Papillomavirus Vaccines