TY - JOUR
T1 - Documenting human papillomavirus vaccine refusal among adolescents in electronic health records
T2 - A mixed methods study
AU - Vielot, Nadja A.
AU - Ballard, Christine A.P.
AU - St Jean, Denise T.
AU - Page, Sophie
AU - Hammond, Kelli
AU - Thompson, Peyton
AU - Butler, Anne M.
AU - Ranney, Leah M.
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/12/2
Y1 - 2024/12/2
N2 - Background: Human papillomavirus (HPV) vaccination is often refused by patients or caregivers. We conducted a mixed-methods study to understand how health care providers document HPV vaccination refusal and use this information in subsequent encounters. Methods: Using electronic health records (EHR) in a public academic health system, we identified patients aged 9–17 years with documentation of refusal of a recommended vaccination in billing codes or clinic notes from October 15, 2015 and December 31, 2021. We summarized the number of encounters in which vaccination was refused; the incidence of HPV vaccination following an initial refusal; and the content of clinic notes describing HPV vaccination refusal. Next, we held focus groups with clinic personnel to understand strategies for documenting HPV vaccination refusal and holding future conversations about HPV vaccination. Results: Of 523 patients with a documented vaccination refusal, 351 (67 %) refused HPV. Of these, 88 (27 %) eventually received HPV vaccination; incidence of vaccination was not associated with the method used to document refusal in the EHR (ICD-10 code versus clinic note). From focus group discussions, we learned that providers usually make brief notes describing when HPV vaccination was offered and refused, and generally plan to recommend vaccination again at a subsequent encounter. Documenting specific reasons for refusal (e.g., patient age, a conflicting priority) was considered helpful to guide future conversations. Conclusions: Patients who refuse HPV vaccination might accept vaccination in the future if providers continue to recommend it. Documenting the refusal in EHR can provide meaningful context to guide subsequent recommendations.
AB - Background: Human papillomavirus (HPV) vaccination is often refused by patients or caregivers. We conducted a mixed-methods study to understand how health care providers document HPV vaccination refusal and use this information in subsequent encounters. Methods: Using electronic health records (EHR) in a public academic health system, we identified patients aged 9–17 years with documentation of refusal of a recommended vaccination in billing codes or clinic notes from October 15, 2015 and December 31, 2021. We summarized the number of encounters in which vaccination was refused; the incidence of HPV vaccination following an initial refusal; and the content of clinic notes describing HPV vaccination refusal. Next, we held focus groups with clinic personnel to understand strategies for documenting HPV vaccination refusal and holding future conversations about HPV vaccination. Results: Of 523 patients with a documented vaccination refusal, 351 (67 %) refused HPV. Of these, 88 (27 %) eventually received HPV vaccination; incidence of vaccination was not associated with the method used to document refusal in the EHR (ICD-10 code versus clinic note). From focus group discussions, we learned that providers usually make brief notes describing when HPV vaccination was offered and refused, and generally plan to recommend vaccination again at a subsequent encounter. Documenting specific reasons for refusal (e.g., patient age, a conflicting priority) was considered helpful to guide future conversations. Conclusions: Patients who refuse HPV vaccination might accept vaccination in the future if providers continue to recommend it. Documenting the refusal in EHR can provide meaningful context to guide subsequent recommendations.
KW - Adolescents
KW - Health care providers
KW - Human papillomavirus
KW - Vaccine hesitancy
KW - Vaccines
UR - http://www.scopus.com/inward/record.url?scp=85207176135&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2024.126467
DO - 10.1016/j.vaccine.2024.126467
M3 - Article
C2 - 39467411
AN - SCOPUS:85207176135
SN - 0264-410X
VL - 42
JO - Vaccine
JF - Vaccine
IS - 26
M1 - 126467
ER -