Clinician Prompts for Human Papillomavirus Vaccination: A Cluster Randomized Trial

Area of Science:

• Pediatric primary care
• Public health interventions
• Vaccination programs

Background:

• Missed opportunities for human papillomavirus (HPV) vaccination remain a challenge in primary care settings.
• Online interventions and clinician prompts are potential strategies to improve vaccination rates.

Purpose of the Study:

• To assess the impact of an online intervention using clinician prompts on HPV vaccination missed opportunities.
• To evaluate the effectiveness of prompts in reducing missed opportunities for initial and subsequent HPV vaccine doses.

Main Methods:

• A cluster randomized controlled trial involving 48 primary care pediatric practices.
• Intervention group received online training and weekly "quick tips" on implementing staff and EHR prompts.
• Logistic regression models were used to assess missed opportunities, accounting for practice clustering.

Main Results:

• Missed opportunities for HPV vaccination increased in both intervention and control groups during the study period.
• However, missed opportunities for the initial HPV vaccine at well child care visits decreased by 4.5 percentage points more in the intervention group.
• No significant differences were observed for subsequent doses or at non-well child care visits.

Conclusions:

• Clinician prompts, delivered via an online intervention, can reduce missed opportunities for initial HPV vaccination at well child care visits.
• Worsening missed opportunities in both groups may be linked to understaffing, exacerbated by the COVID-19 pandemic.
• Full implementation of prompted interventions may be hindered by practice-level challenges such as understaffing.