Using Health Information Technology to Improve Delivery of HPV Vaccine

Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. and a primary risk factor for cervical cancer in women. Black and Hispanic women have higher cervical cancer incidence and mortality due to lower screening and later diagnosis. The vaccine to prevent HPV infection is now recommended for all females aged 11to26 years, and is highly effective if all three doses are received prior to exposure to HPV. Given its high efficacy, the HPV vaccine has the potential to dramatically reduce rates of cervical cancer. Many inner-city adolescents begin the HPV vaccine series, but few complete the three-dose series within the recommended timeframe. If poor and minority women have lower rates of vaccination than those in higher income groups, it could widen the disparity in cervical cancer rates and mortality that currently exists.

The overall objectives of this study were to 1) assess parent preferences for communicating with their adolescent’s physician and 2) implement a health informatics-based intervention to reduce missed opportunities, reduce intervals between doses, and increase completion of the HPV vaccination series in inner-city practices.

The specific aims of the project were as follows:

• Measure preferences for parents of adolescents and adolescents themselves to understand how they prefer to receive immunization reminders and other information from the adolescent’s physician (e.g., phone, mail, email, text messages, personal health records [PHRs]). 
• Measure baseline rates of missed opportunities for HPV vaccination, the intervals between HPV vaccine doses, and the proportion of patients who received 1, 2, or 3 vaccinations. 
• Develop and implement a health information technology-based intervention to reduce missed opportunities, reduce intervals between doses, and increase completion of the HPV vaccination series in inner-city practices. 
• Measure the post-intervention rates and analyze data. 

Four-hundred parents of adolescents (aged 11-17) completed a survey to assess their perspectives about preferences for communication with the adolescent’s physician, half in an urban area and half in a suburban area. They found that just over half of parents were accepting of their teens receiving their own vaccine reminders. Urban parents preferred communicating with the provider via telephone, whereas suburban parents preferred email for most issues, and a PHR for receipt of test results. In addition, being a younger parent was associated with preferring text message vaccine reminders.

Two randomized controlled trials were performed comparing use of reminders in three urban primary care clinics. Parents of adolescents 11-17 years old receiving an HPV vaccine chose which method of reminder, either phone or text, they preferred and after consenting were randomized to receive, or not receive, a reminder. Forty-eight percent of phone intervention participants compared to 40 percent of controls had received 3 HPV vaccine doses, while 49 percent of text intervention participants compared to 30 percent of controls completed the course. There was no significant difference in time from enrollment to receipt of the third HPV vaccine dose for those receiving a phone reminder compared to controls, but there was a significant difference in those receiving a text reminder.

Overall the study showed that some, but not all, parents are ready for electronic communication for their adolescents’ health care, and that a parent age and socio-economic divide exists. Providing options in the means in which parents communicate with an adolescent’s provider is ideal.