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Improving adolescent HPV vaccination in a randomized controlled cluster trial using the 4 Pillars™ practice

Richard K Zimmerman1, Krissy K Moehling1, Chyongchiou J Lin1

  • 1Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.

Vaccine
|November 24, 2016
PubMed
Summary

The 4 Pillars™ Practice Transformation Program effectively increased human papillomavirus (HPV) vaccine initiation in adolescents. This intervention shows promise for improving adolescent immunization rates in primary care settings.

Keywords:
AdolescentsHPV vaccineImmunizationMCV vaccineTdap vaccine

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Area of Science:

  • Adolescent Health
  • Vaccinology
  • Public Health Interventions

Background:

  • Adolescent vaccination rates for meningococcal (MCV) and tetanus, diphtheria, and pertussis (Tdap) vaccines are nearing Healthy People 2020 goals.
  • Human papillomavirus (HPV) vaccine uptake remains suboptimal among adolescents.
  • Primary care practices are key settings for improving adolescent immunization coverage.

Purpose of the Study:

  • To evaluate the effectiveness of the 4 Pillars™ Practice Transformation Program in increasing HPV, MCV, and Tdap vaccination rates among adolescents.
  • To assess the impact of a multi-strategy intervention on adolescent vaccination initiation and completion in primary care.

Main Methods:

  • A randomized controlled cluster trial involving 20 primary care practices (9 intervention, 11 control).
  • Data extracted from electronic medical records for 10,861 adolescent patients (11-17 years old).
  • Comparison of vaccination rates and percentage point changes between intervention and control groups before and after the intervention period.

Main Results:

  • The intervention group showed a significantly greater increase in HPV vaccine initiation (10.2 percentage points) compared to the control group (7.3 percentage points) (P<0.001).
  • Implementation of over 10 strategies from the program significantly increased the likelihood of HPV series initiation (OR=2.06).
  • No significant difference in HPV series completion rates was observed between the groups.

Conclusions:

  • The 4 Pillars™ Practice Transformation Program, utilizing over 10 strategies, is effective in boosting HPV vaccine series initiation among adolescents.
  • The findings support the use of practice transformation programs to address gaps in adolescent immunization coverage.