Health care providers\u2019 perceptions of use and influence of clinical decision support reminders: qualitative study following a randomized trial to improve HPV vaccination rates

Brian E Dixon,Shannon Wilson,Gregory D Zimet,Monica L Kasting,Stephen M Downs,Amit Kulkarni

doi:10.1186/s12911-017-0521-6

Abstract

BackgroundHuman Papillomavirus (HPV) leads to serious health issues and remains the most common sexually transmitted infection. Despite availability of effective vaccines, HPV vaccination rates are suboptimal. Furthermore, providers recommend the HPV vaccine less than half the time for eligible patients. Prior informatics research has demonstrated the effectiveness of computer-based clinical decision support (CDS) in changing provider behavior, especially in the area of preventative services.MethodsFollowing a randomized clinical trial to test the effect of a CDS intervention on HPV vaccination rates, we conducted semi-structured interviews with health care providers to understand whether they noticed the CDS reminders and why providers did or did not respond to the prompts. Eighteen providers, a mix of medical doctors and nurse practitioners, were interviewed from five publicly-funded, urban health clinics. Interview data were qualitatively analyzed by two independent researchers using inductive content analysis.ResultsWhile most providers recalled seeing the CDS reminders, few of them perceived the intervention as effective in changing their behavior. Providers stated many reasons for why they did not perceive a change in their behavior, yet the results of the trial showed HPV vaccination rates increased as a result of the intervention.ConclusionsCDS reminders may be effective at changing provider behavior even if providers perceive them to be of little use.Trial registrationClinicalTrials.gov Identifier: NCT02551887Registered on September 15, 2015

Highlights

Human Papillomavirus (HPV) leads to serious health issues and remains the most common sexually transmitted infection
We summarize the qualitative analysis of interviewers conducted after the trial in order to understand whether providers noticed the clinical decision support (CDS) reminders, which prompted providers to recommend HPV vaccination
In response to specific questions during the interview, providers commented on both their awareness and utilization of the CDS reminders

Summary

Introduction

Human Papillomavirus (HPV) leads to serious health issues and remains the most common sexually transmitted infection. Despite the availability of a 9-valent HPV vaccine (9vHPV) that prevents up to 80–90% of cervical cancers and 90% of genital warts [3], HPV vaccination rates in the U.S remain lower than desired to best protect the population against HPV infection [4]. Existing research demonstrates that many physicians do not strongly endorse HPV vaccination or do not deliver timely recommendations [6, 7]. This is of particular concern because one of the strongest predictors of vaccine uptake is healthcare provider recommendation, and a lack of provider recommendation has been reported as a key reason for non-vaccination [8,9,10,11,12]

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