Background: Human papillomavirus (HPV) is a common virus. There are more than 100 types of HPV. About 70% of cervical cancers cases are caused by only 2 of the 15 cancer-causing types of HPV these two are called HPV 16 and HPV 18. Approximately 1 in 4 females between the ages of 14 and 59 has HPV. Over a lifetime, about 8 in 10 women will have at least one HPV infection. The availability of an HPV vaccine has positioned primary care providers (PCPS) to play an active role in ensuring its successful implementation. However, there needs to be a systematic approach to increasing HPV vaccination rates during the clinical encounter. Furthermore, providers must be aware of common knowledge, attitudes and belief barriers associated with HPV and the vaccine that are often encountered during clinical visits. Foreground: Primary care providers are uniquely positioned to deliver an HPV vaccination strategy to their communities since most preventive care service occur in the outpatient setting. In 2006, the United States Food and Drug Administration approved the first HPV vaccine for females between the ages of 9 and 26 to protect them against the 6, 11,16, 18 HPV strains. Phase I and III clinical trials have shown the vaccine to be efficacious in preventing cytologic abnormalities, genital warts, and vulvar or vaginal neoplasia. Prevention rates were high in these studies, ranging 89-100%. The availability of the HPV has positioned primary care providers (PCPs) to play an active role in ensuring its successful implementation. However, there needs to be a systematic approach to increasing HPV vaccination rates during the clinical encounter. Several clinical practice guidelines (CPGs) released by guideline developers allow the PCP to systematically by develop statements to assist practitioners and patient decisions about appropriate health care for specific circumstances. Prior to this project, none has been adopted by the providers at the clinic where this project took place. Methods: The objective of this project was to establish a system in which females could receive the HPV vaccine series. A needs assessment was done to determine the number of females in the practice that met the criteris for vaccination using the billing code from the electronic medical record (EMR) system. Next, a meeting to discuss the project with the stakeholders to assure everyone was vested in the project occured. Third, the clinic staff was educated about the project to guarantee integrity and consistency. Fourth, a timeframe was developed to implement the CPG. Lastly, a reminder system was devised for the second and third injection to assure females completed the series. Framework: The theoretical foundation for this project is the Health Belief Model (HBM). The evidenced-based practice model utilized for this project was the Rosswurm and Larrabee’s model. Additionally, the mnemonic utilized for motivating interviewing of female patients was the 5 A’s. The 5 A’s stand for awareness, assess, address, acceptability and activate. Findings/Results: When visiting with the stakeholders, patients and caregivers, it was very apparent that they were unaware of the prevalence of the HPV infection and the development of the HPV vaccine. All groups were eager to learn about the HPV infection and vaccine, as well as prevention. Additionally, during interviews with females that were sexually active, most were agreeable to be immuized against the HPV infection. Although in visiting with parents or legal guardians about immunizing young females there was more hesitation. Post the implementation of the CPG, there was a notable increase in the percentage of females receiving the HPV vaccine. However, the most concerning finding was that the family practice clinic was not enrolled in the state immunization program requiring the females to go to the local health department for the vaccine. Conclusion/Recommendation: If health care providers endorsed the immunization females wanted to know more about HPV and many got immunized. Although educating patients about the negative effects of HPV and steps to take for prevention were paramount, immunization was essential. In addition, it was recommended that the clinic be enrolled in the state immunization program to reduce the number of missed opportunities to immunize females against this disease.
