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Improving Human Papillomavirus (HPV) Vaccination in the Postpartum Setting

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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.

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Acknowledgments

Thank you Kurt Yoshino, MD (research assistant), University of Hawai'i Residents and Faculty, Hawai'i Pacific Health Research Institute, Kapi'olani Medical Center for Women and Children Outpatient Clinic; JJC was partially supported by Grants U54MD007584 and P20GM103466 from the National Institutes of Health.

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Authors and Affiliations

  1. 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

    Reni Soon, Stephen Sung & Mark Hiraoka

  2. Imi Hale Native Hawaiian Cancer Network, Honolulu, HI, USA

    May Rose Dela Cruz

  3. 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

    John J. Chen

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  1. Reni Soon
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  2. Stephen Sung
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  3. May Rose Dela Cruz
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  4. John J. Chen
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Correspondence to Reni Soon.

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Soon, R., Sung, S., Cruz, M.R.D. et al. Improving Human Papillomavirus (HPV) Vaccination in the Postpartum Setting. J Community Health 42, 66–71 (2017). https://doi.org/10.1007/s10900-016-0230-6

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