Sharon Sears takes pride in the fact that she listens to her children’s doctors. So when Dr. Dorian Roye at Cumberland Diagnostic & Treatment Center told Sears that it may be a good time for her 13-year-old daughter Shemiza to receive her first Human Papillomavirus (HPV) vaccination, she listened.
“I know that at certain ages, children have to get vaccines,” Sears said. “I said yes.”
Shemiza Sears has now had all three of the required HPV vaccinations, and said that getting them was no big deal. “My arm got stiff and hurt a little, but my mom just told me to exercise it, and that worked.”
Those three shots will help Shemiza against invasive cervical cancer, a disease that afflicted 12,200 American women and caused 4,210 deaths in 2010, according to American Cancer Society estimates. Most of those cervical cancers were caused by the HPV virus.
Cynthia Boakye, MD, MPH, Associate Medical Director at Cumberland D&TC, is a driving force behind a successful effort to increase the number of young women vaccinated against the disease by increasing compliance and expanding access to this safe and effective vaccine.
The vaccine is recommended and deemed safe by a number of medical groups, including the American Academy of Pediatrics, the American Cancer Society and the Institute of Medicine.
“When the first HPV vaccine was introduced in 2006 we realized how important it was to give it before girls became sexually active. We also recognized that we had a lot of missed opportunities. A girl would come in with a cold and we had no standard way to check if she was also due for her second HPV vaccination,” Boakye said. “It was also very difficult to get the young patients back for the essential second and third shots, which need to be administered within two and six months respectively.”
In 2008, only 27 percent of 9-12 year old middle school girls who came to Cumberland D&TC or to one of its Child Health Clinics with a parent had the entire three-dose series. Among 13-to-18-year-olds, 53 percent completed the series, partly because nurse-practitioners in neighborhood high schools administered the vaccine, making compliance easier. Among the 19-21 age group, only 38 percent had all three of the required shots.
To improve the rates, Dr. Boakye first created a multi-disciplinary team of physicians, nurse-practitioners, nurses, clerical and administrative staff, and representatives from quality management and health analytics, to identify why the young female patients did not complete the necessary course of vaccinations. They quickly learned that the obstacles varied from cultural issues to lack of phone numbers for follow up.
Despite the challenges, the team set a very ambitious goal of 90 percent compliance.
“We decided to make the HPV vaccine a routine part of child care, in the same way that we regularly give other childhood vaccines,” Dr. Boakye said. “Now every patient who receives a vaccination injection at Cumberland D&TC leaves with a reminder to come back, receives another reminder just before her appointment, and gets a ‘broken appointment’ phone call if she misses her next scheduled vaccination. But we are still challenged with wrong and disconnected phone numbers, making it difficult to get everyone back as needed.”
That commitment to consistency and follow up has worked. By the end of 2010, compliance rates among all age groups had a measurable increase: 35 percent among 9-12 yr. olds, 87 percent for 13-18 year olds, and 61 percent for 19-21 year olds.
Dr. Boakye is thrilled.
“We had to educate patients and parents on the importance of the vaccine, dispel some of their misunderstanding and reinforce the benefits,” she said. “While the statistics for cervical cancer remain alarming, I truly believe that by improving compliance with the HPV vaccine among our patients, we will help decrease the incidence of this cancer in the future.”October 2011