HPV vaccine standing orders and communication in primary care: A qualitative study.

Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 8406899 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2518 (Electronic) Linking ISSN: 0264410X NLM ISO Abbreviation: Vaccine Subsets: MEDLINE

Publication: Amsterdam, The Netherlands : Elsevier Science
Original Publication: [Guildford, Surrey, UK] : Butterworths, [c1983-

Papillomavirus Vaccines*/administration & dosage ; Primary Health Care* ; Papillomavirus Infections*/prevention & control ; Qualitative Research* ; Vaccination*/statistics & numerical data; Humans ; Female ; Male ; Child ; Standing Orders ; Health Personnel ; Adolescent ; Communication ; Adult

Background: Standing orders may improve HPV vaccination rates, but clinical staff's readiness to use them has not been well-explored. We sought to explore benefits and challenges to using HPV vaccine standing orders for adolescents ages 9 to 12, understand clinical staff roles in communication about HPV vaccine, and how standing orders can reduce barriers contributing to vaccine disparities among racial and ethnic marginalized groups.
Methods: Participants were a sample of 16 U.S. nurses, medical assistants, and healthcare providers working in primary care, recruited from June to September 2022. Trained staff conducted virtual, semi-structured qualitative interviews. We analyzed the resulting data using reflexive thematic analysis.
Results: Themes reflected benefits and challenges to using HPV vaccine standing orders and strategies to address clinic barriers to improve vaccine access and HPV vaccine communication. Benefits included faster and efficient clinic flow; fewer missed vaccine opportunities and promotion of early vaccination; and normalization of HPV vaccination as routine care. Challenges included possible exacerbation of existing HPV vaccine communication and recommendation barriers; and how the complexity of the vaccine administration schedule lessens nurses' and medical assistants' confidence to use standing orders. Strategies to address vaccine access barriers included using nurse-only visits to empower nurse autonomy and catch up on HPV vaccination; engaging clinical staff to follow up with overdue children; and educating parents on HPV vaccine before their child is vaccine eligible.
Conclusion: Using HPV vaccine standing orders can promote autonomy for nurses and medical assistants and address vaccine access barriers. Clinical staff engagement and clinic support to mitigate existing vaccine communication barriers are needed to empower staff to use of HPV vaccine standing orders.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Dr. Brewer has served as a paid consultant for Merck, the Centers for Disease Prevention and Control, and the World Health Organization. Mr. Kahn has served as a paid consultant for the World Health Organization. All other authors declared no potential conflicts of interest].
(Copyright © 2024 Elsevier Ltd. All rights reserved.)

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P01 CA250989 United States CA NCI NIH HHS

Keywords: Communication; HPV; Immunization; Primary care; Standing orders; Vaccination

0 (Papillomavirus Vaccines)

Date Created: 20240530 Date Completed: 20240711 Latest Revision: 20240714

20240714

PMC11242613

10.1016/j.vaccine.2024.05.008

38816304