As chair of general pediatrics for a large medical group, I knew our HPV vaccination rates back in 2016 were low, but didn’t completely understand why. I’m here to share how we figured it out, and how we improved.
The first task was to understand the barriers, and we went straight to the front line. Our doctors and staff explained reasons why this vaccine can be such a hard sell – and what we heard was at times enlightening. For the doctors, refuting incorrect information about this vaccine on the internet can be exhausting and time-consuming. Some medical assistants were calling out the vaccine as somehow different (“Your doctor will talk to you about HPV”), inadvertently flagging the vaccine as controversial or optional. Parents often felt that even talking about HPV was an uncomfortable reminder that their child would probably eventually (or maybe even soon) have sex! We heard that teenagers are busy, and it’s impossible to get in to get the booster dose during regular clinic hours. We heard a lot of “well, it’s just hard – everyone’s vaccine rates for HPV are low.”
Our department set a 10 percent increased vaccination rate improvement goal for 2017, and another 10 percent for 2018. We also leveraged our data team to help us produce monthly reports comparing vaccination rates clinic to clinic (we found that encouraging friendly competition is very motivating!). We also produced reports of kids who had started the series, but needed to come in for completion.
Each clinic was asked to do a front line improvement (FLI) project to increase its HPV vaccination rates. As we started seeing the vaccination rates creep up, we chose best practices and spread these across our geography. Some of these best practices were obvious (calling patients to remind them to come back for the booster dose), but some were pretty out of the box. Medical assistants now use new verbiage while rooming, informing parents, “Your child is due for TDap, HPV and meningitis vaccines today” (a.k.a. the sandwich technique). We lowered the recommended age for administration of the first dose from 11 years old to 10 years old and found increased acceptance from parents; we speculate because parents aren’t in the “teen sex” frame of mind yet. We also opened vaccine clinics on the weekends and after school. Doctors received individual vaccination rate reports for their practices and reflected on these to earn maintenance of certification points with the American Board of Pediatrics.
It’s working! Our rates of vaccine completion have jumped dramatically over the last two years. Our vaccination rates are now significantly higher than the national and state numbers. We expect these numbers to continue to rise and have set a new goal for 2019. Of all the important work we do, if pediatricians can prevent cancer, we should do that. Most importantly, our project shows that we can do hard things, even when they seem insurmountable, one step at a time.
Elizabeth Copeland is a pediatrician.
Image credit: Shutterstock.com