Physician Intentions and HPV Vaccination: The First Year

A10 High risk types of HPV are necessary though not sufficient causes of the vast majority of cervical cancers. With the approval by FDA of the HPV vaccine among women age 9-26, dissemination is critical. Fewer than one-third of the US population has heard of HPV. Few know about its association with cervical cancer, and how to prevent its spread. Even fewer women discuss HPV with their health care providers, even though provider counseling for HPV prevention is recommended by the AMA guidelines for adolescent preventive services. Finally, physician recommendation is key to vaccination. As little is known about (1) physician intentions to vaccinate and (2) their vaccination practices, the study addresses these aims, among a sample of 235 multi-ethnic/racial, urban primary care physicians who are enrolled in an RCT of an educational intervention. Baseline findings on intention were collected via self-report, and vaccination practices at followup were measured via medical audit. Prior to the approval of the vaccine, findings revealed strong intention to vaccinate among physicians, at 92% extremely or somewhat likely to vaccinate. Those who were more familiar with the American Cancer Society recommendations for cervical cancer screening had stronger intentions to vaccinate than those with less familiarity with the guidelines (p=.001). Multivariate analyses of primary care physicians revealed that those who regularly performed recto-pelvic examinations on asymptomatic women (beta=0.21, p=.03), and those who were more familiar with the ACS screening guidelines held stronger intentions to vaccinate (beta=0.24, p=0.01) than did comparable others. Female primary care physicians had stronger intentions to vaccinate for HPV than male providers (beta=0.21, p=.03). Post approval, results revealed that dissemination of the HPV vaccine is limited, with 10% of primary care physicians reporting vaccination to age-eligible young women. Major barriers are awareness, cost, and availability of the vaccine. The findings reveal stronger intentions to vaccinate than contemporaneous population-based surveys (80%), but similar predictors in gender and knowledge. The rate of vaccination is comparable to the 14% for the Hepatitis B vaccine among children one year post-approval, but much lower than among pediatricians in a Boston metropolitan hospital (57%) during a similar period of time. This is the first study to observe vaccination intentions among urban physicians working in under-resourced communities, and to systematically report the HPV vaccination practices among primary care physicians who are practicing in these same neighborhoods. The findings reveal the critical imporance of targeted dissemination strategies to urban primary care physicians in under-resourced communities.