Increasing Human Papillomavirus Vaccine Uptake in Primary Care Using the 4 Pillars Program: A Quality Improvement Project

Aim: To explore the effectiveness of the 4 Pillars Program on increasing human papillomavirus vaccination use in patients ages 9-18 years.Design: A retrospective quasi-experimental research design comparing pre- and post-implementation human papillomavirus vaccination rates.Keywords: human papillomavirus, vaccination, pillars, program, communication, tool, quasi-experimental, retrospectiveMethods: A retrospective chart review identified the rate of encounters per provider where the human papillomavirus vaccine was administered to patients ages 9-18 years. Interventions including increasing access to the vaccine, standardizing provider recommendation of the vaccine, enhancing utilization of the electronic health record, and introducing a vaccine champion, known as the 4 Pillars Program, was implemented at an ambulatory care. Following implementation, a chart review was performed and the resulting rate of encounters per provider was compared to the pre-implementation human papillomavirus vaccination rates.Results: No significant change in human papillomavirus vaccination series initiation or completion or missed opportunities was observed. An association between vaccine refusal and patient age and race was found. Providers reported forgetting to offer the vaccine series 25% of the time on average.Conclusion: The 4 Pillars Program was found to have no significant effect on the initiation and completion of the human papillomavirus vaccine series or rate of missed opportunities.Implications: This project found that providers frequently forgot to recommend the human papillomavirus vaccine series during qualifying encounters. The findings suggest more emphasis should be placed on increasing provider recognition of patient-centered vaccine series need so that rates of initiation and completion may increase.Impact: This project addressed the under use of human papillomavirus vaccination and the impact that the 4 Pillars Program has on the uptake of the vaccine. This project found that the 4 Pillars Program did not significantly change vaccination rates. This research impacts future research to be performed on increasing human papillomavirus vaccination rates as it was determined that there is a need to identify strategies that increase provider recognition of patient-centered HPV series need.