Abstract
ObjectiveSafety net health care centers in the US serve vulnerable and underinsured females. The primary aim of this work was to determine if HPV4 dosing compliance differs between females who receive doses at rural vs. urban core safety net health care locations.MethodsFemales exclusively receiving health care in the Truman Medical Center (TMC) safety net system at the urban core and rural locations were identified by their HPV4 vaccine records. Dates and number of HPV4 doses as well as age, gravidity, parity and race/ethnicity were recorded from the electronic medical record (EMR). Appropriate HPV4 dosing intervals were referenced from the literature.Results1259 females, 10–26 years of age, received HPV4 vaccination at either the rural (23%) or urban core location (77%). At the rural location, 23% received three doses on time, equal to the 24% at the urban core. Females seen in the urban core were more likely to receive on-time doublet dosing than on-time triplet dosing (82% vs. 67%, p<0.001). Mistimed doses occurred equally often among females receiving only two doses, as well as those receiving three doses.ConclusionsCompliance with on-time HPV4 triplet dose completion was low at rural and urban core safety net health clinics, but did not differ by location.
Highlights
The Healthcare Research and Quality Act of 1999 (Public Law 106–129) has recognized the existence of health care disparities in the US
A decade ago significantly fewer women in rural areas underwent Pap screening than their urban counterparts [7,9]. This disparity was successfully countered by establishing federally funded Community Health Centers (CHCs) that provided Pap testing along with complete health care: rural women receiving care at a CHC located in the same rural area had a significantly higher rate of Pap testing than did rural women who received health care in a local office [10]
While the rural CHC was successful in rural locations; urban CHCs still provided a higher rate of Pap testing to urban women [11]
Summary
This retrospective study was approved by the University of Missouri-Kansas City School of Medicine Adult Health Sciences Institutional Review Board (IRB) (#12–351) and no verbal or written consents were required. All patients seeking care at Truman Medical Center (TMC) must sign a permission form for their EMR data to be used for any research or investigative purposes; the IRB approved this without any need for separate consent forms. The main HPV4 vaccination study was conducted in the TMC safety net health care system to evaluate adherence to the three dose schedule [13]. The time horizon for the study was July 1, 2006 through October 1, 2009, the dates during which HPV4 was the exclusively approved prophylactic HPV vaccine in the US. During this time frame, commercial advertising for HPV4 was intense. We derived the Cochran-Armitage test for trend by using a transformation of the linear-by-linear association provided by SPSS [23,24]
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