A retrospective analysis and quality improvement education initiative to increase HPV vaccination rates in an inner city primary care clinic.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 213-213
Author(s):  
Jasmin Hundal ◽  
Matthew J Hadfield ◽  
Alifaiz Saiyed ◽  
William Rabitaille
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Hpv Vaccine ◽  
Current Practice ◽  
Insurance Coverage ◽  
Hpv Vaccination ◽  
Shared Decision ◽  
Resident Physicians ◽  
Internal Medicine Residents ◽  
Attending Physicians

213 Background: Human papillomavirus (HPV) is the most commonly spread sexually transmitted infection and is implicated in the oncogenesis of several cancers, including cervical, anal,vaginal and oropharyngeal cancers. HPV vaccinations have a high efficacy, and recent data demonstrated adults aged 18-26 years old are not adequately fully vaccinated. Our objective was to assess the current practice regarding HPV vaccination among persons 9-45 years of age, knowledge about the HPV guidelines, and recommendation practice. Methods: A retrospective review was conducted of Internal Medicine residents acting as primary care physicians at an urban clinic based in Hartford, Connecticut, USA. The survey was administered to internal medicine residents and attending physicians to assess the current practice regarding the HPV vaccination for adults and knowledge of the updated guidelines. The key drivers identified were resident knowledge, communication, insurance coverage, and availability of HPV vaccination in the clinic. An educational handout and lecture was provided with a follow-up survey. Results: A total of 347 charts were reviewed. Of those eligible to receive the HPV vaccine, it was found that only 5.2% received the total dosage. The response rate to our initial survey was 60%. 47.83% did not inquire about the HPV vaccination or recommended it to patients compared to 71.43% of attending physicians (AP) who inquired, but only 28.47% discussed it during precepting sessions. 27.7% of the residents and 71.43% AP correctly identified the updated guidelines. The biggest three barriers were unfamiliarity with the availability of HPV vaccination, insurance coverage, and current guidelines. A short educational review and summary were provided to close the gaps identified with the questionnaire.100% of residents correctly identified the updated guidelines, risks, benefits, importance of shared decision-making, and more likely recommend the HPV vaccination. However, 69.2% were unaware that HPV vaccination does not prevent the progression of HPV-related cancers. Conclusions: Adherence to CDC guidelines regarding vaccinating against HPV amongst resident physicians is poor. The percentage of patients, who received the complete Gardasil-9 vaccination series, was significantly below the national average. Our study highlights a large practice gap that exists amongst resident physicians regarding the HPV vaccine. There was minimal documentation amongst resident physicians regarding shared decision-making conversations with patients. We addressed the knowledge and resource deficit with an educational handout and information session. Our intervention demonstrated improved confidence in discussing the vaccine with the patients and resolved the concern of insurance coverage and availability of vaccines in the clinic and pharmacy.

Pharmacogenomics education and perceptions: is there a gap between internal medicine resident and attending physicians?

2021 ◽  
Author(s):  
Carolyn R Rohrer Vitek ◽  
Jyothsna Giri ◽  
Pedro J Caraballo ◽  
Timothy B Curry ◽  
Wayne T Nicholson
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Internal Medicine Resident ◽  
Current Clinical Practice ◽  
Medicine Resident ◽  
Resident Physicians ◽  
Internal Medicine Residents ◽  
Care Gaps ◽  
Attending Physicians ◽  
Do So

Aim: To determine if differences in self-reported pharmacogenomics knowledge, skills and perceptions exist between internal medicine residents and attending physicians. Materials & methods: Forty-six internal medicine residents and 54 attending physicians completed surveys. Thirteen participated in focus groups to explore themes emerging from the surveys. Results: Resident physicians reported a greater amount of pharmacogenomics training compared with attending physicians (48 vs 13%, p < 0.00012). No differences were found in self-reported knowledge, skills and perceptions. Conclusion: Both groups expressed pharmacogenomics was relevant to their current clinical practice; they should be able to provide information to patients and use to guide prescribing, but lacked sufficient education to be able to do so effectively. Practical approaches are needed to teach pharmacogenomics concepts and address point-of-care gaps.

scholarly journals Quality of Outpatient Care With Internal Medicine Residents vs Attending Physicians in Veterans Affairs Primary Care Clinics

2019 ◽  
Vol 179 (5) ◽  
pp. 711 ◽  
Author(s):  
Samuel T. Edwards ◽  
Hyunjee Kim ◽  
Sarah Shull ◽  
Elizabeth R. Hooker ◽  
Meike Niederhausen ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Outpatient Care ◽  
Veterans Affairs ◽  
Primary Care Clinics ◽  
Internal Medicine Residents ◽  
Attending Physicians

HPV Vaccine Initiation and Completion Among Native Hawaiian and Pacific Islander Adults, United States, 2014

2021 ◽  
pp. 101053952110274
Author(s):  
Sameer Vali Gopalani ◽  
Amanda E. Janitz ◽  
Sydney A. Martinez ◽  
Janis E. Campbell ◽  
Sixia Chen
Keyword(s):  
United States ◽  
Logistic Regression ◽  
Vaccination Coverage ◽  
Hpv Vaccine ◽  
Regression Models ◽  
Insurance Coverage ◽  
Hpv Vaccination ◽  
Pacific Islander ◽  
Logistic Regression Models ◽  
Vaccine Initiation

Native Hawaiian and Pacific Islander (NHPI) adults bear a disproportionate burden of certain human papillomavirus (HPV)-associated cancers. In 2015, data from the National Health Interview Survey (NHIS) showed vaccination coverage among adults by racial and ethnic groups; however, coverage data for NHPI adults were unavailable. In this study, we estimated the initiation and completion of HPV vaccination and assessed the factors associated with vaccination among NHPI adults aged 18 to 26 years in the United States. We analyzed public data files from the 2014 NHPI NHIS (n = 1204). We specified sampling design parameters and fitted weighted logistic regression models to calculate the odds of HPV vaccine initiation. We developed a directed acyclic graph to identify a minimally sufficient set for adjustment and adjusted for insurance coverage (for education and ethnicity) and doctor visit (for insurance coverage, earnings, ethnicity, and sex). Overall, 24.9% and 11.5% of NHPI adults had initiated and completed the HPV vaccination series, respectively. Weighted logistic regression models elucidated that the odds of HPV vaccine initiation were higher for females (weighted odds ratio = 5.4; 95% confidence interval = 2.8-10.4) compared with males. Low vaccination coverage found among NHPI adults provides an opportunity for targeted programs to reduce the burden of HPV-associated cancers.

scholarly journals A Novel Contraception Counseling and Shared Decision-Making Curriculum for Internal Medicine Residents

MedEdPORTAL ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 11046
Author(s):  
Rebeca Ortiz Worthington ◽  
Julie Oyler ◽  
Amber Pincavage ◽  
Nabil Abou Baker ◽  
Mark Saathoff ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Internal Medicine Residents ◽  
Contraception Counseling

scholarly journals Pharmacists’ Perceived Barriers to Human Papillomavirus (HPV) Vaccination: A Systematic Literature Review

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1360
Author(s):  
Oluwafemifola Oyedeji ◽  
Jill M. Maples ◽  
Samantha Gregory ◽  
Shauntá M. Chamberlin ◽  
Justin D. Gatwood ◽  
...  
Keyword(s):  
Hpv Vaccine ◽  
System Organization ◽  
Insurance Coverage ◽  
Hpv Vaccination ◽  
The United States ◽  
Perceived Barriers ◽  
Lack Of Information ◽  
Inadequate Knowledge ◽  
In Series ◽  
The Cost

About 45:000 cancers are linked to HPV each year in the United States alone. The HPV vaccine prevents cancer and is highly effective, yet vaccination coverage remains low. Pharmacies can play a meaningful role in increasing HPV vaccination access due to their availability and convenience. However, little is known about pharmacists’ perceived barriers to HPV vaccination. The objective of this systematic review was to summarize existing literature on perceived barriers to administering HPV vaccination reported by pharmacists. Barriers identified from selected studies were synthesized and further grouped into patient, parental, (pharmacist’s) personal, and system/organization barrier groups. Six studies were included in this review. The cost of the HPV vaccine, insurance coverage and reimbursement were commonly reported perceived barriers. Adolescent HPV vaccination barriers related to parental concerns, beliefs, and inadequate knowledge about the HPV vaccine. Perceived (pharmacist’s) personal barriers were related to lack of information and knowledge about HPV vaccine and recommendations. At the system/organization level, barriers reported included lack of time/staff/space; difficulty in series completion; tracking and recall of patient; perceived competition with providers; and other responsibilities/vaccines taking precedence. Future strategies involving pharmacy settings in HPV-related cancer prevention efforts should consider research on multilevel pharmacy-driven interventions addressing barriers.

scholarly journals Patient-Level Factors Associated With Lack of Health Care Provider Recommendation for the Human Papillomavirus Vaccine Among Young Cancer Survivors

2020 ◽  
Vol 38 (25) ◽  
pp. 2892-2901
Author(s):  
Jocelyn M. York ◽  
James L. Klosky ◽  
Yanjun Chen ◽  
James A. Connelly ◽  
Karen Wasilewski-Masker ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Health Care Provider ◽  
Care Provider ◽  
Hpv Vaccine ◽  
Insurance Coverage ◽  
Hpv Vaccination ◽  
Factors Associated ◽  
Patient Level ◽  
Vaccine Recommendation

PURPOSE Young cancer survivors are at increased risk for morbidities related to infection with the human papillomavirus (HPV), yet their HPV vaccine initiation rates remain low. Patient-/parent-reported lack of health care provider recommendation for HPV vaccination is strongly associated with vaccine noninitiation. We aimed to identify patient-level factors associated with survivor-/parent-reported lack of provider recommendation for HPV vaccination among young cancer survivors. METHODS Cancer survivors ages 9-26 years and 1-5 years off therapy completed a cross-sectional survey (parent-completed for survivors 9-17 years of age). Lack of health care provider HPV vaccine recommendation was the outcome of interest in a multivariable logistic regression model that included relevant patient-level sociodemographic, clinical, and vaccine-related variables. RESULTS Of 955 survivors, 54% were male, 66% were non-Hispanic White, and 36% had leukemia. At survey participation, survivors were an average age (± standard deviation) of 16.3 ± 4.7 years and 32.8 ± 14.7 months off therapy. Lack of provider HPV vaccine recommendation was reported by 73% (95% CI, 70% to 75%) of survivors. For the entire cohort, patient-level factors associated with lack of reported provider recommendation included perceived lack of insurance coverage for the HPV vaccine (odds ratio [OR], 4.0; 95% CI, 2.7 to 5.9; P < .001), male sex (OR, 2.8; 95% CI, 1.9 to 4.0; P < .001), and decreased parent-survivor communication regarding HPV vaccination (OR, 1.7 per unit decrease in score; 95% CI, 1.3 to 2.2; P < .001). In the sex- and age-stratified models, perceived lack of insurance coverage (all models) and male sex (age-stratified models) were also significantly associated with lack of reported provider recommendation. CONCLUSION We identified factors characterizing survivors at risk for not reporting receipt of a health care provider HPV vaccine recommendation. Future research is needed to develop interventions that facilitate effective provider recommendations for HPV vaccination among all young cancer survivors.

scholarly journals BELIEFS REGARDING GERIATRICS PRIMARY CARE TOPICS AMONG MEDICAL STUDENTS AND INTERNAL MEDICINE RESIDENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S297-S297
Author(s):  
Dylan J Jester ◽  
Kathryn Hyer ◽  
Ross Andel
Keyword(s):  
Internal Medicine ◽  
Older Adults ◽  
Primary Care ◽  
Medical Students ◽  
Psychiatric Symptoms ◽  
Content Areas ◽  
Internal Medicine Residents ◽  
Images Of Aging ◽  
The Difference ◽  
First Year Medical Students

Abstract Our study evaluated and contrasted responses to 25 content areas essential to the primary care of older adults by medical students and residents, and identified attitudes toward aging amongst students and residents. One hundred and thirty-six medical students and 61 Internal Medicine residents completed a survey including the 25-item Geriatrics Clinician-Educator Survey and 18-item Images of Aging Scale. Students and residents rated importance and knowledge for content areas from 1 (low) to 10 (high). Gap scores reflecting the difference in ratings between importance and knowledge were calculated. The Images of Aging scale ranges between 0 (furthest from what you think) and 6 (closest to what you think). Results indicated that students and residents reflected similar beliefs about the importance of content areas, but students provided lower ratings in knowledge. Students revealed larger gap scores in areas that reflected general primary care (e.g., assess chronic conditions, medications), whereas residents revealed larger gap scores in areas that reflected specialists’ expertise (e.g., driving risk, cognition, psychiatric symptoms). Attitudes toward older adults did not differ appreciably between students and residents. In sum, primary care topics applicable for any age demographic were rated as most important by first-year medical students and Internal Medicine residents. Topics relevant to older populations – particularly those requiring specialists’ knowledge of or requiring sensitive discussion with older adults – were rated as less important and were less well mastered.

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