Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. 461-466 (doi:10.1542/peds.2007-0012)
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ARTICLE

Additional Health Care Visits Needed Among Adolescents for Human Papillomavirus Vaccine Delivery Within Medical Homes: A National Study

Cynthia M. Rand, MD, MPH, Peter G. Szilagyi, MD, MPH, Christina Albertin, MPH and Peggy Auinger, MS

Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York

OBJECTIVE. We estimated the additional number of primary care visits needed to deliver 3 doses of human papillomavirus vaccine to all US adolescents in medical homes. We determined adolescent and family factors associated with needing the greatest number of additional visits for full human papillomavirus vaccination.

METHODS. We performed a cross-sectional analysis of adolescents 11 to 21 years of age included in the 2002 and 2003 Medical Expenditure Panel Surveys (n = 2900) to measure existing primary care visits to pediatricians, family physicians, obstetrician/gynecologists, and internists. We then estimated additional visits needed for human papillomavirus vaccination. We determined the number of additional visits needed within a 6-, 12-, 18-, or 24-month vaccination window.

RESULTS. Within a 12-month period, 72% of female adolescents would need 3 visits for human papillomavirus vaccination if the vaccine was introduced at a preventive visit; 9% and 16% would need 1 and 2 more visits, respectively. Similarly, 79% of male patients would need 3 visits; 7% and 12% would need 1 and 2 more visits, respectively. If all opportunities to vaccinate were used, then 41% of female patients and 52% of male patients would need 3 additional visits within 12 months. With expansion of the window to 24 months and vaccination at every possible visit, 23% of female patients and 37% of male patients would need 3 additional visits. Factors that predicted needing more visits (2 or 3 vs 0 or 1 in 24 months) included being older, male, black, Hispanic, uninsured, and near-poor.

CONCLUSIONS. Most adolescents would require 2 or 3 additional primary care visits to receive 3 vaccines for human papillomavirus in the medical home. Strategies to minimize additional visits include vaccinating patients at all primary care visits and encouraging annual preventive visits.

Key Words: adolescent health • utilization of services • health services research • immunizations

Abbreviations: HPV—human papillomavirus

Accepted Apr 23, 2007.