[Leslie Carol Botha: Even with chart stamping the HPV vaccination rate still remained below 50%. This – due in part to 54% of girls who refuse the vaccine because the they saw You Tube videos of girls who have suffered adverse reactions. Medical consumers are speaking out…using social media and have become an effective force in alerting others to the dangers of Gardasil and Cervarix. Thin line between stamping charts and coercion.]
Reminder Stamp Boosts HPV Vaccination
By Ed Susman, Contributing Writer, MedPage Today
Published: May 11, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
SAN DIEGO — Rubber stamping a patient’s chart with a reminder about the human papillomavirus (HPV) vaccine was associated with a greater than four-fold increase in vaccination rates at one institution.
At the start of the study, the charts of eligible patients in the outpatient gynecological setting indicated that 11% were following through with the HPV vaccination, but after the reminder stamp was added to the charts, the vaccination rate increased to 49% (P<0.0001), said Kerry Rut, DO, of Winthrop University Hospital, Mineola, N.Y., and colleagues.
“We were aiming to at least get our institution at the national level or 25%, but were really able to greatly exceed that,” Rut told MedPage Today at her poster presentation during the annual clinical meeting of the American College of Obstetricians and Gynecologists. “We think that the reminder was the main factor in getting more compliance with the vaccine.”
The authors began by determining the baseline vaccination rate at their outpatient office from March to May of 2010. They created a “Gardasil Vaccination Reminder” stamp and progress notes were stamped from June 2010 to December 2010. Charts were assessed to establish a vaccination rate with the stamp.
They found that vaccination rates after introduction of the reminder stamp (49%) were significantly better than baseline (11%) for an odds ratio of 4.64 (P<0.0001).
They also reported that documentation of a discussion about the vaccine between patient and healthcare provider was evident in 90% of the stamped charts compared with only 22% of the charts without the stamp (P<0.0001).
Logistic regression demonstrated that age, type of insurance, reason for visit, and history of abnormal PAP smears were not independently associated with vaccination.
The only independent variable was use of the stamp, the authors stated.
But the stamp could not overcome all barriers to HPV vaccination. Rut reported that 54% of the women or girls refused the vaccine, even after counseling. “We were told numerous times that the girls who refused had seen a YouTube video purportedly showing a girl disabled by the vaccine. We have no way of knowing if the film clip is genuine, but we know it is keeping many of our patients from getting the vaccination,” she said.
However, Rut also noted that the stamp improved the performance of the healthcare professionals in terms of vaccine delivery. At baseline, one provider had successfully vaccinated 33% of her patients, but boosted that number to 79% with the presence of the red reminder stamp on the charts (P=0.04).