Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Hum Vaccin Immunother. 2023 Aug;19(2):2264596. doi: 10.1080/21645515.2023.2264596. Epub 2023 Oct 17.
Expanding access to HPV vaccination is critical to increasing HPV vaccine uptake. We assessed the determinants and barriers to consistent offering of HPV vaccine among healthcare facilities. This was a cross-sectional survey of healthcare providers (HCPs) in Texas. Prevalence of the reasons healthcare practices do not consistently offer HPV vaccination was estimated. Multivariable regression analyses were conducted. Of 1169 HCPs included in the study, 47.5% (95% CI: 44.6-50.3%) reported their practices do not provide HPV vaccination or do not offer it consistently. Compared to physicians, nurses had 77% lower odds (Adjusted Odds Ratio (AOR): 0.23, 95% CI: 0.16-0.32, -value: < .001), and physician assistants had 89% lower odds (AOR: 0.11, 95% CI: 0.07-0.16, -value: < .001) of their healthcare practices consistently offering HPV vaccination. Compared to university/teaching hospitals, the odds of healthcare practices consistently offering HPV vaccination were 44% lower (AOR: 0.56, 95% CI: 0.35-0.91, p-value: 0.019) in solo practices but 266% higher (AOR: 3.66, 95% CI: 2.04-6.58, -value: < .001) in FQHC/public facilities. The common reasons healthcare practices do not consistently offer HPV vaccination were; HPV vaccination is not within the scope of the practice (48.1%), referrals to other clinics (27.7%), and limited personnel (11.4%). Non-physicians were more likely to report that HPV vaccination was not in their scope and to refer patients than physicians. Moreover, solo practices were more likely to report challenges with acquisition and storage of the vaccine and referral of patients as reasons for not consistently offering HPV vaccination than university/teaching hospitals, FQHC/public facilities, or group practices. System-level interventions including training of non-physicians and expansion of practice enrollment in programs that support HPV vaccine acquisition and storage are needed.
扩大人乳头瘤病毒 (HPV) 疫苗的可及性对于提高 HPV 疫苗的接种率至关重要。我们评估了医疗保健机构中持续提供 HPV 疫苗的决定因素和障碍。这是一项对德克萨斯州医疗保健提供者 (HCP) 的横断面调查。估计了医疗实践中不持续提供 HPV 疫苗的原因的流行率。进行了多变量回归分析。在纳入研究的 1169 名 HCP 中，47.5%(95%CI:44.6-50.3%)报告他们的实践不提供 HPV 疫苗或不持续提供 HPV 疫苗。与医生相比，护士提供 HPV 疫苗的可能性低 77%(调整后的优势比(AOR):0.23,95%CI:0.16-0.32, -值:<0.001)，而医师助理提供 HPV 疫苗的可能性低 89%(AOR:0.11,95%CI:0.07-0.16, -值:<0.001)。与大学/教学医院相比，医疗实践持续提供 HPV 疫苗的可能性低 44%(AOR:0.56,95%CI:0.35-0.91, p 值:0.019)，而在独立实践中则高 266%(AOR:3.66,95%CI:2.04-6.58, -值:<0.001)。医疗实践不持续提供 HPV 疫苗的常见原因是;HPV 疫苗不在实践范围内(48.1%)，转诊到其他诊所(27.7%)，人员有限(11.4%)。非医生比医生更有可能报告 HPV 疫苗不在他们的范围内，并将患者转介出去。此外，与大学/教学医院、家庭健康中心/公共设施或团体实践相比，独立实践更有可能报告在获取和储存疫苗方面存在挑战以及将患者转介作为不持续提供 HPV 疫苗的原因。需要进行系统层面的干预，包括培训非医生，并扩大实践参与支持 HPV 疫苗获取和储存的计划。
