Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients

"This work supports previous findings that electronic reminders are effective at increasing immunizations and potentially decreasing healthcare costs for the treatment of HPV-related cancers."

Exposure to negative information on human papillomavirus (HPV) vaccination and mistrust in the medical system/healthcare providers is associated with parental hesitancy towards HPV vaccination. Past research has identified several evidence-based strategies for improving vaccination rates, including patient reminder or recall system interventions. The present study involved creating customised electronic reminder messages that paired strong provider recommendations with brief education and emphasis on the importance and cancer prevention. This study evaluated the effectiveness of using customised electronic reminders, paired with strong provider recommendations for HPV vaccination and messaging on the importance of cancer prevention, to increase HPV vaccinations among adolescents and young adults in Texas, United States.

The study population included 7,408 patients aged 9-25 who: (i) had at least one office visit at a primary care clinic in 2021, (ii) were eligible to receive the HPV vaccine but either had not yet received it or had initiated but did not complete the HPV vaccine series), and (iii) had a valid communication method such as mobile phone number, email address, or patient portal activation documented within the electronic health record (EHR) system (e.g., MyChart, a web-based patient portal in Epic that allows patients access to their medical records and to communicate with their providers). Using stratified randomisation, participants were divided into two groups: usual care (control) (N = 3,703) and intervention (N = 3,705).

The control group received usual care including in-person provider recommendations, visual reminders in exam waiting rooms, bundling of vaccinations, and phone call reminders. The intervention group received usual care and an electronic reminder (SMS (text messaging), email or patient portal message) at least once and up to 3 times (spaced at an interval of 1 reminder per month). The electronic reminder was addressed to the parent/caregiver or patient (based on the patient's age) and included physician recommendation (with the physician's name) and brief education

The intervention group had a 17% statistically significantly higher odds of uptake of additional HPV vaccinations than the usual care group (adjusted odds ratio (AOR): 1.17, 95% confidence interval (CI): 1.01-1.36). Patients who received the intervention were also more likely to schedule an appointment (AOR: 1.2, 95% CI: 1.06-1.37) and have an additional HPV vaccination (AOR: 1.35, 95% CI: 1.14-1.59) compared to the usual care group patients. In addition, among the intervention group HPV vaccine initiation rate (AOR: 1.32, 95% CI: 1.04-1.68) and completion rate (AOR: 1.32, 95% CI: 1.12-1.56) were significantly higher than those among the usual care group.

Thus, this study provides evidence that customised electronic patient reminders tailored to include an HPV vaccine recommendation from the patient's primary care provider may increase HPV vaccination. The literature supports provider recommendations to increase vaccination, and this study shows an electronic practical solution for healthcare clinics.

According to the researchers, although the initial cost of adopting a systems-level patient reminder tool can be significant, maintenance costs are relatively minimal. In addition, adopting automated patient reminder tools may minimise the human capital resources that are typically needed to manually place individual phone calls and allow for the customisation of messages and tailored interventions.

In conclusion, future research could investigate: whether this message framework is useful to other patient populations, whether customising EHR reminder interventions based on risk or culture is effective, and if the pragmatic approach is applicable to other healthcare settings. Furthermore, healthcare organisations may consider customised electronic reminders for other immunisations, such as flu or pneumonia, as well as other preventative care activities.