Molokwu Jennifer, Mendez Melissa, Bracamontes Christina
Department of Family And Community Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States.
Department of Obstetrics and Gynecology, Hospital Corporation of America Las Palmas Del Sol Healthcare, El Paso, TX, United States.
JMIR Cancer. 2023 Mar 15;9:e42890. doi: 10.2196/42890.
The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age.
Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population.
We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015.
We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96% vs 21.22%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7% and 58.36%; P<.001).
Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates.
人乳头瘤病毒（HPV）与外阴癌、阴道癌、阴茎癌、宫颈癌、肛门癌及口咽癌的发病机制相关。它是美国最常见的性传播感染。尽管HPV疫苗的安全性和有效性已有文献记载，但其接种率仍落后于同年龄段接种的其他疫苗。
医疗服务提供者的推荐被认为是HPV疫苗接种的有力预测指标，并且医生提示总体上能增加预防性保健服务的提供。从理论上讲，向医疗服务提供者提供提醒应能增加HPV疫苗推荐的机会，从而影响疫苗接种率。我们研究的目的是评估电子病历（EMR）提示在以西班牙裔边境人群为主的学术诊所环境中提高HPV疫苗接种率的有效性。
我们采用了带有回顾性病历审核的准实验设计，以评估临床决策提示（CDP）对不同专科环境中提高HPV免疫接种率的效果。我们引入了一个EMR提示，以提醒医疗服务提供者在位于得克萨斯州与墨西哥边境的一个大型多专科学术团体的妇产科（OBGYN）、儿科（PD）和家庭医学（FM）诊所中，见到合适患者时推荐HPV疫苗。我们评估了引入提示前后所有相关科室的HPV疫苗接种率。参与者包括2014年1月至2015年12月期间在诊所就诊的9至26岁的男性和女性患者。
我们审查了所有3个诊所的2800多份病历。在对年龄、种族、民族、保险类型、首选语言和诊所进行调整后，EMR提示实施后患者的免疫接种几率提高了92%（P<0.001）。此外，实施CDP后，HPV疫苗总体接种完成率在统计学上有显著总体提高（31.96%对21.22%；P<0.001）。同样，妇产科的疫苗接种完成率改善最为显著，随访时的接种率比基线率高66.02%（P = 0.04）。儿科和家庭医学科的改善虽有些类似但同样令人印象深刻（分别为57.7%和58.36%；P<0.001）。
实施EMR CDP使我们HPV疫苗接种完成的总体几率提高了92%。我们推测决策提示能提醒医疗保健提供者在临床服务过程中讨论或推荐HPV疫苗接种。EMR中的CDP有助于提高多个专科的HPV疫苗接种率，是提高疫苗接种率的低成本干预措施。
