Abstract B106: Provider factors associated with HPV vaccination among low-income 9- to 17-year-old girls

Abstract

Abstract Background: Low-income and minority women bear a disproportionate burden of cervical cancer. Many women who develop cervical cancer are eligible for or are participants of Medicaid. Providing human papillomavirus (HPV) vaccination to girls in Medicaid may help reduce subsequent cervical disparities observed in low-income and minority women. Provider recommendation is a critical factor associated with HPV vaccination. Purpose: The primary aim of this study was to evaluate provider characteristics associated with HPV vaccination among 9–17 year old female Medicaid enrollees. Methods: A sample of 800 providers was randomly selected from the Florida Medicaid Master Provider File. The sampling frame was restricted to providers who had: a physical address in Florida, billed claims or an assigned panel that included 25 or more 9–17 year old girls in the past year, and a specialty of Pediatrics, Obstetrics and Gynecology, or Family Medicine that included internal medicine, general practice, or preventive medicine. Physicians were mailed a survey in October 2009 that evaluated key factors related to HPV vaccination, including: 1) demographic and practice characteristics, 2) HPV information and knowledge, 3) barriers to HPV vaccination, 4) vaccine practices, and 5) vaccine recommendation practices. To measure HPV vaccination, Medicaid claims data were used to calculate the proportion of eligible patients who received at least one dose of the vaccine from sampled providers within the study period. Provider factors (e.g., provider specialty) associated with HPV vaccination at the bivariate level were evaluated simultaneously in a multiple linear regression model with HPV vaccination as the outcome variable. Results: The response rate was 68.3% (n = 485). After excluding respondents who identified themselves as unlikely to be involved in vaccination (e.g., hospice, emergency care providers; n = 23) or reported a specialty other than what was requested or no specialty (n = 23), the current analysis included 439 providers. The prevalence of HPV vaccination ranged from 0% to 61.9% (mean = 19.9, SD = 14.4). About 33% of the variance in HPV vaccine administration was attributable to the independent variables, F(14, 382) = 13.2, p < .0001, adjusted R2 = 0.3. Provider factors significantly associated with HPV vaccination included provider specialty, private vs. other practice, daily patient load, VFC provider status, patient race, and referring out for HPV vaccination. Private vs. other practice (e.g., ambulatory care clinic of hospital or medical center, urgent care clinic, community health center) was the strongest predictor of HPV vaccination (beta = −0.3, p < .0001). Conclusions: HPV vaccination has the potential to reduce cervical cancer disparities among low-income and minority women. Despite the financial coverage of the HPV vaccine for Medicaid-eligible girls, the average vaccination rates are low. Results of the current study can be used to target health services interventions to those providers least likely to administer HPV vaccine to female Medicaid enrollees. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B106.