Who Offers the HPV Vaccine? A Survey of US Physicians
Daley MF, Crane LA, Markowitz LE, et al
Pediatrics. 2010;126:425-433
Two vaccines currently target human papillomavirus (HPV): a quadrivalent vaccine approved in 2006, and a bivalent version approved in 2009. Current recommendations are to begin the vaccination series for girls at 11-12 years of age, in part to cluster adolescent vaccines, but also because these vaccines are effective in preventing long-term disease only if people receive them before exposure to the virus.
Daley and colleagues surveyed a national network of pediatricians and family medicine physicians to determine practices with respect to HPV vaccines. The network was developed by the Centers for Disease Control and Prevention (CDC) and includes a nationally representative sample of pediatricians and family physicians (FPs). The survey response rate was approximately 80%, with 349 pediatricians and 331 FPs providing data. The median year of medical school graduation was 1985 for pediatricians and 1987 for FPs, and slightly more than 50% of the respondents were men. Only 13% of pediatrician respondents were in rural practice locations, compared with 28% of FP respondents. More than 80% of pediatricians but only 58% of FPs participated in the Vaccines for Children program. In general, more than 80% of all providers felt comfortable discussing sexuality issues with patients who were adolescent girls, but most noted that getting adolescents to come in for healthcare visits was a challenge.
With respect to knowledge assessment, most physicians knew that HPV was a common sexually transmitted infection. However, 49% of pediatricians and 45% of FPs wrongly answered "true" to a question that the highest incidence of HPV occurs among people in their 30s. A large proportion did not realize that the HPV serotypes that cause genital warts are not the same serotypes that cause cervical disease. Many incorrectly thought that a pregnancy test should be performed before administering HPV vaccine. Finally, more than 20% did not know that HPV vaccine was not licensed for use in women older than 26 years. Similarly, approximately 20% did not know that a previous HPV diagnosis does not preclude women from receiving HPV vaccine.
Common practice barriers to delivering HPV vaccine that 25% of survey respondents identified were cost-related concerns, including reimbursement and upfront costs. Physicians also identified parental concerns (all in the 20%-35% range) about HPV vaccine as a barrier to delivery, noting parental concerns about vaccine safety, moral and religious reasons for vaccine refusal, and concerns that receipt of the HPV vaccine might be associated with earlier sexual activity in their daughters. Most physicians offered the vaccine in their practices (98% of pediatricians, 88% of all FPs, and 95% of female FPs), but not all "strongly recommended" the vaccine. Barriers to strongly recommending HPV vaccines to 11- and 12-year-old girls were the time required to discuss the vaccine with parents, concerns that the provider needed to discuss sexuality before offering the vaccine, and concerns that these girls and their parents would be less likely to accept vaccination than would older girls. The investigators concluded that nearly all pediatricians and most family physicians offer HPV vaccines to 11- and 12-year-old girls.
I take these figures as overall encouragement that the HPV vaccines are quickly becoming standard. The advent of other vaccines given during adolescence has helped to make administration of the HPV vaccine more of an office routine than an event that requires its own prompting and execution. In addition, clustering HPV vaccine delivery with other vaccines should help increase HPV acceptance by parents, as more come to see these early adolescent visits as extensions of preschool preventive care visits. One unintended outcome of the increased emphasis on adolescent vaccination may be an increase in how often adolescents actually make health maintenance visits. In addition, the need to track so many vaccines in adolescents has no doubt led practices to improve methods of identifying and tracking vaccine-deficient adolescents, who are often overlooked in the push to get younger children up to date on vaccine coverage.
Abstract
Human Papillomavirus Vaccination Practices: A Survey of US Physicians 18 Months After Licensure
Daley MF, Crane LA, Markowitz LE, et al
Pediatrics. 2010;126:425-433
Study Summary
Two vaccines currently target human papillomavirus (HPV): a quadrivalent vaccine approved in 2006, and a bivalent version approved in 2009. Current recommendations are to begin the vaccination series for girls at 11-12 years of age, in part to cluster adolescent vaccines, but also because these vaccines are effective in preventing long-term disease only if people receive them before exposure to the virus.
Daley and colleagues surveyed a national network of pediatricians and family medicine physicians to determine practices with respect to HPV vaccines. The network was developed by the Centers for Disease Control and Prevention (CDC) and includes a nationally representative sample of pediatricians and family physicians (FPs). The survey response rate was approximately 80%, with 349 pediatricians and 331 FPs providing data. The median year of medical school graduation was 1985 for pediatricians and 1987 for FPs, and slightly more than 50% of the respondents were men. Only 13% of pediatrician respondents were in rural practice locations, compared with 28% of FP respondents. More than 80% of pediatricians but only 58% of FPs participated in the Vaccines for Children program. In general, more than 80% of all providers felt comfortable discussing sexuality issues with patients who were adolescent girls, but most noted that getting adolescents to come in for healthcare visits was a challenge.
With respect to knowledge assessment, most physicians knew that HPV was a common sexually transmitted infection. However, 49% of pediatricians and 45% of FPs wrongly answered "true" to a question that the highest incidence of HPV occurs among people in their 30s. A large proportion did not realize that the HPV serotypes that cause genital warts are not the same serotypes that cause cervical disease. Many incorrectly thought that a pregnancy test should be performed before administering HPV vaccine. Finally, more than 20% did not know that HPV vaccine was not licensed for use in women older than 26 years. Similarly, approximately 20% did not know that a previous HPV diagnosis does not preclude women from receiving HPV vaccine.
Common practice barriers to delivering HPV vaccine that 25% of survey respondents identified were cost-related concerns, including reimbursement and upfront costs. Physicians also identified parental concerns (all in the 20%-35% range) about HPV vaccine as a barrier to delivery, noting parental concerns about vaccine safety, moral and religious reasons for vaccine refusal, and concerns that receipt of the HPV vaccine might be associated with earlier sexual activity in their daughters. Most physicians offered the vaccine in their practices (98% of pediatricians, 88% of all FPs, and 95% of female FPs), but not all "strongly recommended" the vaccine. Barriers to strongly recommending HPV vaccines to 11- and 12-year-old girls were the time required to discuss the vaccine with parents, concerns that the provider needed to discuss sexuality before offering the vaccine, and concerns that these girls and their parents would be less likely to accept vaccination than would older girls. The investigators concluded that nearly all pediatricians and most family physicians offer HPV vaccines to 11- and 12-year-old girls.
Viewpoint
I take these figures as overall encouragement that the HPV vaccines are quickly becoming standard. The advent of other vaccines given during adolescence has helped to make administration of the HPV vaccine more of an office routine than an event that requires its own prompting and execution. In addition, clustering HPV vaccine delivery with other vaccines should help increase HPV acceptance by parents, as more come to see these early adolescent visits as extensions of preschool preventive care visits. One unintended outcome of the increased emphasis on adolescent vaccination may be an increase in how often adolescents actually make health maintenance visits. In addition, the need to track so many vaccines in adolescents has no doubt led practices to improve methods of identifying and tracking vaccine-deficient adolescents, who are often overlooked in the push to get younger children up to date on vaccine coverage.
Abstract
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