title: Potential barriers to HPV vaccine provision among medical practices in an area with high rates of cervical cancer.
abstract: OBJECTIVE
  Potential barriers to widespread vaccination of adolescent girls against human papillomavirus (HPV) infection are poorly understood. We provide an overview of potential barriers to provision of HPV vaccine and empirical data on the concerns of medical practices that may inhibit HPV vaccine provision.
  
  
  METHODS
  We conducted phone interviews with medical practices in rural areas in southeastern North Carolina with high rates of cervical cancer to assess 10 potential concerns about HPV vaccine provision.
  
  
  RESULTS
  Concerns most commonly reported by medical practices (N = 71) were inadequate reimbursement (68%), high cost of the vaccine to patients (66%), and burden of determining insurance coverage (66%). Practices that were not providing the vaccine reported more concerns about HPV vaccine provision on average than practices providing the vaccine (6.0 vs. 4.5 concerns, p < .05).
  
  
  CONCLUSIONS
  Medical practices' concerns about the HPV vaccine may be barriers to stocking it and, thus, to providing it to adolescents. Even providers who stock the vaccine reported concerns. Research is needed to address ways to ameliorate these medical practices' concerns and also to understand other potential barriers to vaccine coverage.
authors.affiliation: School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27516, USA.
authors.forename: Katie M
authors.initials: KM
authors.lastname: Keating
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
authors.forename: Sami L
authors.initials: SL
authors.lastname: Gottlieb
authors.forename: Nicole
authors.initials: N
authors.lastname: Liddon
authors.forename: Christina
authors.initials: C
authors.lastname: Ludema
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D001291:Attitude of Health Personnel; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007349:Insurance, Health, Reimbursement; D009657:North Carolina / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics / Q000600:supply & distribution; D010290:Parents; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians'; D019035:Rural Health Services; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines