title: Provider-Level Characteristics Associated With Adolescent Varicella, Meningococcal, and Human Papillomavirus Immunization Initiation.
abstract: OBJECTIVE
  We examined patient- and provider-level factors associated with initiation of three adolescent immunizations among 13 to 18 year olds in an adolescent primary care clinic.
  
  
  METHODS
  Data were extracted retrospectively from medical records. Logistic regression models identified associations with immunization initiation. Post hoc analyses stratified by gender were conducted to examine provider-type contribution to human papillomavirus (HPV) immunization initiation.
  
  
  RESULTS
  Among 2932 adolescents, rates of meningococcal and varicella immunization initiation differed by age. Girls were more likely to have initiated HPV immunization than boys. The probability of girls initiating HPV immunization was the same when last seen by advanced practice nurses (APNs) versus physicians, but the probability of boys initiating HPV immunization was lower when last seen by APNs.
  
  
  CONCLUSIONS
  Differences in HPV immunization initiation were observed between genders, and for boys, between APN versus physician at last clinic visit. This may reflect changes to HPV immunization recommendations for boys and APNs having shorter clinic visits.
authors.affiliation: Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Grout
authors.affiliation: Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Beal
authors.affiliation: Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Kahn
authors.affiliation: Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH USA Lea.Widdice@cchmc.org.
authors.forename: Lea E
authors.initials: LE
authors.lastname: Widdice
mesh_terms: D000293:Adolescent; D019433:Chickenpox Vaccine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D022401:Meningococcal Vaccines / Q000008:administration & dosage*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D019433:Chickenpox Vaccine; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines
keywords: HPV vaccine; advanced practice nursing; health care delivery; health care provider; immunization; nurse practitioners; professional role