Establishing a Standardized Process to Improve Identification and Recommendation Practices of Patients Eligible to Receive the HPV Vaccine Series in a Rural Primary Care Clinic

Abstract

Problem: Human Papillomavirus (HPV) is a common sexually transmitted infection that will affect over 80% of sexually active men and women in their lifetime. HPV is the primary cause of cervical cancer in women and is linked to oropharyngeal and anal cancers in both men and women. The HPV vaccine can be given as early as 11 years of age to both boys and girls. If administered before exposure to the virus, the vaccine can protect against the cancer-causing strains of HPV. Despite this cancer prevention, there remains a low rate of HPV vaccine coverage among adolescents across the U.S. Project Aim: The aim of this quality improvement project is to implement a standardized process for identifying patients in need of the vaccine and providing consistent recommendation for vaccination in a rural primary health care clinic. Project Method: The project was implemented in a rural Kansas family practice clinic. Lewin’s theory of change and three-step change model was be used as a theoretical framework to guide the implementation of this project. The project began with a discussion with clinic providers and staff on barriers and current practices for identifying and recommending HPV vaccination. A process map for identification was created utilizing staff input. An educational in-service was provided to educate on the new process for identification of eligible patients, updated HPV-related information, and strategies for recommendation practices. After education, the identification and recommendation standardized process was followed and tracked for approximately 4 weeks. Results/Conclusion: Themes were identified and evaluated based on feedback from clinic staff and a process map was created for the clinic as a standardized process for practice change. Overall, 44 patients were identified as age-eligible to receive recommendation for the HPV vaccine. Over half of these patient encounters were for acute or sick visits. These patients would have otherwise been missed opportunities prior to the clinic practice change. Although there was no impact on vaccine administration rates observed, the results support standardized processes to screen eligible patients at every visit as an effective way for improving identification and recommendation for age-eligible patients in need of the HPV vaccine.