Additional Health Care Visits Needed Among Adolescents for Human Papillomavirus Vaccine Delivery Within Medical Homes

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http://pediatrics.aappublications.org/cgi/content/abstract/120/3/461?ct

Published online August 31, 2007

PEDIATRICS Vol. 120 No. 3 September 2007, pp. 461-466

(doi:10.1542/peds.2007-0012)

ARTICLE

Additional Health Care Visits Needed Among Adolescents for Human

Papillomavirus Vaccine Delivery Within Medical Homes: A National Study

M. Rand, MD, MPH, G. Szilagyi, MD, MPH, Albertin,

MPH and Peggy Auinger, MS

Department of Pediatrics, University of Rochester School of Medicine and

Dentistry, Rochester, New York

OBJECTIVE. We estimated the additional number of primary care visits needed

to deliver 3 doses of human papillomavirus vaccine to all US adolescents in

medical homes. We determined adolescent and family factors associated with

needing the greatest number of additional visits for full human

papillomavirus vaccination.

METHODS. We performed a cross-sectional analysis of adolescents 11 to 21

years of age included in the 2002 and 2003 Medical Expenditure Panel

Surveys (n = 2900) to measure existing primary care visits to

pediatricians, family physicians, obstetrician/gynecologists, and

internists. We then estimated additional visits needed for human

papillomavirus vaccination. We determined the number of additional visits

needed within a 6-, 12-, 18-, or 24-month vaccination window.

RESULTS. Within a 12-month period, 72% of female adolescents would need 3

visits for human papillomavirus vaccination if the vaccine was introduced

at a preventive visit; 9% and 16% would need 1 and 2 more visits,

respectively. Similarly, 79% of male patients would need 3 visits; 7% and

12% would need 1 and 2 more visits, respectively. If all opportunities to

vaccinate were used, then 41% of female patients and 52% of male patients

would need 3 additional visits within 12 months. With expansion of the

window to 24 months and vaccination at every possible visit, 23% of female

patients and 37% of male patients would need 3 additional visits. Factors

that predicted needing more visits (2 or 3 vs 0 or 1 in 24 months) included

being older, male, black, Hispanic, uninsured, and near-poor.

CONCLUSIONS. Most adolescents would require 2 or 3 additional primary care

visits to receive 3 vaccines for human papillomavirus in the medical home.

Strategies to minimize additional visits include vaccinating patients at

all primary care visits and encouraging annual preventive visits.

Key Words: adolescent health • utilization of services • health services

research • immunizations

Abbreviations: HPV—human papillomavirus

Accepted Apr 23, 2007.

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Sheri Nakken, R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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