Berwick Hospital Center
Bloomsburg Hospital
Evangelical Community Hospital
Geisinger Health System
Shamokin Area Community Hospital
Sunbury Community Hospital
Primary Care Physicians’ Attitudes and Recommendations
of the Gardasil® HPV Vaccine: A Population-based Survey
Nichole Hockenbrock*, Nicole Huey*, Allison Clark*, Brenda Kluhsman, Eugene Lengerich
*ACTION
Health Cancer Task Force
Penn
State University
Background
Problem
Methods
Conclusions
ACTION Health, parent of the ACTION Health Cancer
Task Force, is a nonprofit organization partnering with,
and sponsored by the 6 hospitals within its 5-county
service area: Columbia, Montour, Snyder, Union, and
Northumberland Counties, Pennsylvania (PA). ACTION
Health’s mission is to facilitate community-based
initiatives to improve the health status and quality of life
for area residents. ACTION Health conducts ongoing
community health assessments, prioritizes health
needs, and facilitates collaborative, community-based
interventions. ACTION Health partners with over 65
local agencies.
Cervical cancer is preventable or curable if detected
early. Important strategies to reduce the risk of cervical
cancer include the Papanicolaou (Pap) screening test
and the human papillomavirus (HPV) vaccine. In June
2006, the U.S. Food and Drug Administration approved
the Gardasil® HPV vaccine for females, age 9-26.
• In December 2006, the Task Force placed a phone call
then faxed a survey to all primary care practices (family
medicine, pediatric, and OB/GYN clinics) (n=65) in the
5-county ACTION Health area.
The initial survey assessed:
- Provider recommendation of the vaccine
- Age range of patients offered the vaccine
- Provider concerns
- Acceptance of non-patient referrals
- Willingness to post HPV program flyers
• Most primary care practices in the ACTION Health
service area are providing the HPV vaccine to patients
aged 9-26 as recommended, and this number is growing.
•The largest barrier identified by the survey was cost and
insurance coverage of the vaccine (i.e., some insurance
companies cover HPV vaccination up to age 18 or 21).
• Providers are willing to promote community education
programs about HPV and cervical cancer.
ACTION Health Area Facts*
• Located in North Central PA
• Median population, 42,270
(range 18,069 - 92,879)
• Predominantly Caucasian
• Median age, 39 years
• 52% Rural
• 13% Uninsured (range, 10%-17%)
• Montour County classified as “distressed”, other
counties as “transitional”, by the Appalachian
Regional Commission
*Source: PA Department of Health, 2006 data
Incidence of Cervical Cancer (Invasive):
ACTION Health 5-County Area, 2002-2004
County
Observed
Expected
#Cases
#Cases
Columbia
7
8
Montour
2
2
Northumberland
19
12
Snyder
4
5
Union
2
4
As in other rural PA counties, none of the 5 ACTION
Health counties have met the national Healthy People
2010 goal of 90% of women age 18 and over who had a
Pap smear test for cervical cancer in the past 3 years.
• In May 2007, a follow-up survey was faxed
to providers who completed the first survey.
The follow-up survey also assessed:
- Clinics with patients requesting vaccine
(for self or daughter)
- Doses given per week
- Patient compliance with 2nd and 3rd doses
- Willingness to be a guest speaker for
HPV and cervical cancer programs
Goal
Results
Determine the attitudes and practices of primary
care providers related to the Gardasil® HPV vaccine.
• 55 (83%) providers completed the initial survey;
Of these, 49 (89%) completed the follow-up survey
• 44 (80%) were offering the vaccine to their patients at the
time of the 1st survey; 4 additional providers did so at the
time of the 2nd survey
• 40 (91%) (1st survey) and 37 (76%) (2nd survey) offered
the vaccine to girls and women, aged 9-26
• 41 (84%) reported patient compliance with 2nd & 3rd dose
• 11 (25%) accepted referrals of non-patients
• 30 (68%) were willing to post flyers about HPV
educational programs
• 15 (27%) had concerns about the vaccine, including:
- Cost and insurance 9 (16%)
- Recommended age was too young 4 (7%)
- Vaccine was too new to recommend 2 (4%)
The mission of the ACTION Health Cancer Task Force
is to increase community awareness, education and
early detection of cancer. The Task Force is comprised
of local health and human service representatives,
community volunteers, and cancer survivors. Priority
focus areas include breast, cervical, colorectal, prostate,
and skin cancer.
Task Force members discuss survey results. Right to left:
Cindy Rupp, Lisa Wehr, Sue Mull, Brenda Toter, Nicole Huey,
Brenda Kluhsman
Lessons Learned
• Advance phone call and fax were an effective method to
survey primary care providers.
• Some providers believe the recommended age is too low
for the HPV vaccine and the vaccine promotes sexual
activity among young women.
• Cost is an issue for patients and providers. There is a
gap in access to the vaccine for women aged 18-26.
Next Steps
• Use the survey information to design community- based
HPV and cervical cancer educational programs for each
of the 5 counties.
• Provide the survey results to Merck & Co., Inc. and work
with them to increase accessibility of the vaccine.
Acknowledgements
• Berwick Hospital Center
• Bloomsburg Hospital
• Evangelical Community Hospital
• Geisinger Medical Center
• Shamokin Area Community Hospital
• Sunbury Community Hospital
• American Cancer Society
• Appalachia Community Cancer Network-Penn State
University
• Central Susquehanna Intermediate Unit
• Evangelical Hospital Home Health Services
• PA Department of Health
• SUN Family Planning Plus
• Susquehanna Valley Cancer Center