title: Improving Human Papillomavirus (HPV) Vaccination in the Postpartum Setting.
abstract: Although the HPV vaccine has been shown to be highly effective in preventing cervical dysplasia, vaccination rates remain low. The objective of this study was to assess the effectiveness of an electronic medical record (EMR) prompt on HPV vaccination rates in the postpartum setting. We conducted a pre-post intervention study among postpartum women ages 18-26 seen at an outpatient clinic from 09/01/2012-08/31/2013 (pre-intervention) and from 10/01/2013-03/31/2014 (post-intervention). The intervention was a drop-down menu that was inserted into the EMR postpartum note template inquiring about the patient's HPV vaccination status and whether or not the vaccine was administered at that visit. HPV vaccination uptake was compared pre and post-intervention. Of the 278 postpartum visits during the study period, 241 were eligible for analysis. There was a significant increase of the HPV vaccine uptake, from 1.2 % (2/173) among pre-intervention visits to 26.5 % (18/68) among post-intervention visits (p < 0.001). After adjusting for age, ethnicity, insurance, and religion, HPV vaccination was significantly higher at postpartum visits during the intervention period, with an adjusted OR = 93.49 [95 % CI 15.29-571.52]. Among visits in which the vaccine was not given, HPV vaccination was not discussed in 46 % and patients refused the vaccine in 40 % of visits. An EMR prompt in the postpartum note could be an effective way to promote HPV vaccination in the postpartum setting. It will likely take a combination of strategies to optimize vaccination uptake.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai'i, 1319 Punahou St, Ste 824, Honolulu, HI, 96826, USA. rsoon@hawaii.edu.
authors.forename: Reni
authors.identifier: http://orcid.org/0000-0001-5111-3417
authors.initials: R
authors.lastname: Soon
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai'i, 1319 Punahou St, Ste 824, Honolulu, HI, 96826, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sung
authors.affiliation: Imi Hale Native Hawaiian Cancer Network, Honolulu, HI, USA.
authors.forename: May Rose Dela
authors.initials: MR
authors.lastname: Cruz
authors.affiliation: Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, 1319 Punahou St, Ste 824, Honolulu, HI, 96826, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai'i, 1319 Punahou St, Ste 824, Honolulu, HI, 96826, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000293:Adolescent; D000328:Adult; D065187:Controlled Before-After Studies; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D011181:Postnatal Care / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration; D017010:Reminder Systems; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Electronic medical record; Human papillomavirus; Immunizations; Vaccinations