Abstract
Background
In 2018, only one third of girls and boys completed the 2-dose series of the human
papillomavirus vaccine by their 13th birthday, the target for on-time vaccination.
The study objective was to identify key patient, provider and practice-level factors
associated with on-time vaccination in the primary care setting.
Methods
We examined data from 20 primary care pediatric practices (89 providers) in St. Louis
including: the percentage of eligible patients with on-time vaccination assessed from
medical records; providers’ knowledge, attitudes and behaviors regarding on-time vaccination
assessed with a survey; and practice-level strategies used to optimize vaccine delivery
assessed with a 19-item vaccine delivery system score (VDSS). Factors that increased
on-time vaccination were identified using logistic regression, controlling for clustering
within providers.
Results
Completion of on-time vaccination occurred in 1347/3125 (43.10%) of patients (95%
confidence interval [CI], 41.36%–44.86%) and varied among practices (7.39%–64.24%)
and among providers (2.63%–82.50%). Independent predictors for higher completion of
on-time vaccination included more frequent use by providers of the announcement style
for vaccine recommendation (odds ratio [OR] 1.18, 95% CI, 1.04, 1.35), higher provider
self-efficacy to deliver the vaccine according to guideline recommendations if parents
were hesitant (OR 1.21, 95% CI, 1.05, 1.40), and higher VDSS (OR 1.20, 95% CI, 1.10,
1.31).
Conclusions
Provider and practice-level factors were identified that may represent modifiable
targets for improvement in on-time vaccine uptake. Future research is needed to test
interventions built on these findings.
Keywords
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Article info
Publication history
Published online: December 30, 2022
Accepted:
December 23,
2022
Received:
July 21,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
