Missed Clinical Opportunities Perpetuate Low HPV Vaccination Rate


Two-thirds of young women experienced at least 1 missed opportunity to receive the human papilloma virus vaccine.

A majority of eligible young women may have missed at least 1 opportunity to receive the vaccine against human papillomavirus (HPV) during a visit to an obstetrics and gynecology (OB/GYN) provider, according to a study published by the American Journal of Obstetrics and Gynecology.

The authors also found significant racial disparities in HPV vaccination rates. Black women were 61% more likely to miss an opportunity to receive the vaccine compared with whites, according to the study.

HPV is known to cause numerous cancers, including cervical cancer. Vaccinating young men and women against HPV has proven effective against the development of pre-cancerous lesions. Despite the benefits of immunization, uptake has been particularly slow in the United States, according to the study.

Previous studies have shown that missed clinical opportunities resulted in the low immunization rate. In the current study, the authors aimed to better identify these opportunities.

“We wanted to identify and describe in detail the missed opportunities for administering the HPV vaccine to young adult women,” said senior author Sangini Sheth, MD. “Most studies about missed opportunities for administering the HPV vaccine have focused on adolescents (13-17), but there is still an important role for providers in vaccinating young adult women (18-26) for HPV, especially when the national vaccination rates are lower than the target goals. What we found was that two-thirds of young women had had at least one missed clinical opportunity to receive HPV vaccine, with an average of 1.3 missed opportunities per person.”

Included in the study were the medical records of non-immunized women aged 18 to 26 years who received care at an urban, hospital-based OB/GYN practice. The authors defined a missed opportunity as postpartum check-ups, sexually transmitted disease tests, or contraceptive appointments.

Among patients who experienced at least 1 missed opportunity, 26.5% were administered another vaccine or injectable drug during their visit, according to the study.

“One trend that we observed is that for many of these ‘missed opportunity’ visits, the patients were meeting with a nurse only,” Dr Sheth said. “For example, patients who use the injectable contraceptive, Depo Provera, come to the office every 3 months for a nurse to administer the injection.”

The authors said these findings underscore the urgent need to revise best practices to increase the uptake of the HPV vaccine.

“If we can create a clinical culture where nurses are empowered to discuss, recommend, and administer the HPV vaccine, we could potentially affect the rates of immunization for a population like the one we studied,” Dr Sheth said. “Nurses are always allies and partners in care, especially in preventative and primary care medicine.”

These results can also help providers identify when and where clinical opportunities are missed, which could help increase immunization rates.

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