Uma Deshmukh1, Carlos R Oliveira2, Susan Griggs3, Emily Coleman4, Lital Avni-Singer5, Shefali Pathy6, Eugene D Shapiro7, Sangini S Sheth8. 1. Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, Yale University, PO Box 208063, New Haven, CT 06520-8063, United States. Electronic address: uma.deshmukh@yale.edu. 2. Department of Pediatrics, School of Medicine, Yale University, P.O. Box 208064, New Haven, CT 06520-8064, United States; Department of Investigative Medicine, School of Medicine, Yale University, 2 Church Street South, Suite 114, New Haven, CT 06519, United States. Electronic address: carlos.oliveira@yale.edu. 3. Women's Center Clinic, Yale New Haven Hospital, 789 Howard Ave., New Haven, CT 06519, United States. Electronic address: susan.griggs@ynhh.org. 4. Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States. Electronic address: emily.coleman@yale.edu. 5. Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, Yale University, PO Box 208063, New Haven, CT 06520-8063, United States. Electronic address: lital.avni-singer@yale.edu. 6. Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, Yale University, PO Box 208063, New Haven, CT 06520-8063, United States. Electronic address: shefali.pathy@yale.edu. 7. Department of Pediatrics, School of Medicine, Yale University, P.O. Box 208064, New Haven, CT 06520-8064, United States; Department of Investigative Medicine, School of Medicine, Yale University, 2 Church Street South, Suite 114, New Haven, CT 06519, United States. Electronic address: eugene.shapiro@yale.edu. 8. Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, Yale University, PO Box 208063, New Haven, CT 06520-8063, United States. Electronic address: sangini.sheth@yale.edu.
Abstract
INTRODUCTION: HPV vaccine uptake is lowest among young adults. Little is known about the most effective way to decrease missed opportunities (MO) and increase uptake of the vaccine in this vulnerable population. OBJECTIVES: To determine the impact of a clinical intervention bundle on the rate of MO and uptake of the vaccine among young adult women. METHODS: From 2/2014 to 7/2015, an intervention bundle (designating physician and nurse champions, pre-screening patients' charts, empowering nurses to recommend immunization, providing no-cost vaccinations, placing prompts in clinic note templates, eliminating requirement for pre-vaccination pregnancy test) was implemented at an urban, hospital-based OB/GYN clinic. Medical records were reviewed for all vaccine-eligible (non-pregnant, 11-26 years) women seen between 2/2013 and 9/2016. Impact of the bundled interventions on the monthly rates of MO and vaccine uptake was estimated by analyzing immunization trends with an interrupted time-series model using counterfactual comparison groups in order to control for pre-existing trends. RESULTS: There were 6,463 vaccine-eligible visits during our study period. The prevalence of women who had both completed and initiated the series was significantly higher, 20.3% and 29.7% respectively, in the last month, compared to their counterfactuals (p < 0.01). In the last study month, the rate of MO was significantly lower than its counterfactual (19.73 per 100 encounters lower, p < 0.01). Hispanic women had attributable reductions in their rates of MO that were twice that of White women. Statistically significant attributable reductions were also seen among Spanish speakers, publicly insured, and uninsured women. CONCLUSIONS: Implementation of this intervention bundle effectively reduced the monthly rate of MO and increased the prevalence of women who had initiated and completed the HPV vaccine series. The reduction of MO was most drastic among Hispanic, publicly insured and uninsured women compared to White and privately insured.
INTRODUCTION:HPV vaccine uptake is lowest among young adults. Little is known about the most effective way to decrease missed opportunities (MO) and increase uptake of the vaccine in this vulnerable population. OBJECTIVES: To determine the impact of a clinical intervention bundle on the rate of MO and uptake of the vaccine among young adult women. METHODS: From 2/2014 to 7/2015, an intervention bundle (designating physician and nurse champions, pre-screening patients' charts, empowering nurses to recommend immunization, providing no-cost vaccinations, placing prompts in clinic note templates, eliminating requirement for pre-vaccination pregnancy test) was implemented at an urban, hospital-based OB/GYN clinic. Medical records were reviewed for all vaccine-eligible (non-pregnant, 11-26 years) women seen between 2/2013 and 9/2016. Impact of the bundled interventions on the monthly rates of MO and vaccine uptake was estimated by analyzing immunization trends with an interrupted time-series model using counterfactual comparison groups in order to control for pre-existing trends. RESULTS: There were 6,463 vaccine-eligible visits during our study period. The prevalence of women who had both completed and initiated the series was significantly higher, 20.3% and 29.7% respectively, in the last month, compared to their counterfactuals (p < 0.01). In the last study month, the rate of MO was significantly lower than its counterfactual (19.73 per 100 encounters lower, p < 0.01). Hispanic women had attributable reductions in their rates of MO that were twice that of White women. Statistically significant attributable reductions were also seen among Spanish speakers, publicly insured, and uninsured women. CONCLUSIONS: Implementation of this intervention bundle effectively reduced the monthly rate of MO and increased the prevalence of women who had initiated and completed the HPV vaccine series. The reduction of MO was most drastic among Hispanic, publicly insured and uninsured women compared to White and privately insured.
Authors: Lital Avni-Singer; Carlos R Oliveira; Ashlynn Torres; Eugene D Shapiro; Linda M Niccolai; Sangini S Sheth Journal: Womens Health Issues Date: 2021-03-11
Authors: Lital Avni-Singer; Carlos R Oliveira; Ashlynn Torres; Eugene D Shapiro; Linda M Niccolai; Sangini S Sheth Journal: Obstet Gynecol Date: 2020-11 Impact factor: 7.623
Authors: Mali K Schneiter; Kimberly Levinson; Anne F Rositch; Rebecca L Stone; Amanda Nickles Fader; James Stuart Ferriss; Stephanie L Wethington; Anna L Beavis Journal: Gynecol Oncol Rep Date: 2022-03-03