Pilot evaluation of a clinical decision support system package to facilitate proactive HPV vaccination in community...

Human papillomavirus (HPV) vaccine coverage among US adolescents remains below national targets. Community pharmacies are accessible vaccination sites, but proactive HPV vaccination is hindered by fragmented pharmacy management and immunization information system (IIS) workflows. Clinical decision support systems (CDSS) may reduce these workflow barriers, yet evidence for their utility in pharmacy-based HPV vaccination is limited.

To pilot-test a CDSS package designed to support proactive adolescent HPV vaccination in community pharmacies and to assess early-phase implementation and behavioral outcomes.

CDSS were co-designed with independent pharmacies and technology partners and implemented in a single arm pre/post pilot conducted between April-August 2024. Six pharmacies in Washington State deployed a CDSS package, integrating seven linked components spanning pharmacy-level planning, staff-level point-of-care supports, and parent/patient-level interactions. Pharmacy staff completed baseline and follow-up surveys assessing implementation outcomes (acceptability, appropriateness, feasibility) and targeted vaccination behaviors (recommendation practices, self-efficacy). Pre/post changes were evaluated using descriptive statistics and Wilcoxon signed-rank tests.

Eighteen staff completed surveys; 13 completed pre/post surveys. HPV vaccine recommendations increased from 77% to 100%. Routine recommendation at ages 9-10 increased from 15% to 46%, with fewer staff recommending vaccine at older ages. Self-efficacy for setting vaccination goals improved significantly (mean 3.4 to 4.2/5.0; p=0.012). Implementation outcomes met the threshold for high positive appraisals (mean ≥3.5/5.0) for acceptability (4.0), appropriateness (3.7), and feasibility (3.6). The most adopted CDSS components were the IIS-to-dispensing system data pull (78%), coverage/goal-setting report (72%), and eligibility screening template (72%). Vaccination audit data showed heterogeneous changes across sites.

A co-designed CDSS package was feasible to deploy in pharmacies and improved proactive HPV recommendation behaviors and goal-setting confidence. However, CDSS alone may be insufficient to drive meaningful increases in HPV vaccination rates, as workflow supports cannot substitute for strategies that actively bring adolescents to the pharmacy.