Success of an EMR-Driven Postpartum Intervention to Improve HPV Vaccination Rates.

Human papillomavirus vaccination (HPV) remains low in the United States. The inpatient postpartum setting provides an innovative opportunity to vaccinate eligible patients. This study evaluated two different interventions to improve HPV vaccination rates in hospitalized postpartum patients: a nurse based protocol and an electronic medical record (EMR) postpartum order prompt. This was a comparative intervention study performed in a prospective cohort of postpartum patients at two affiliated County Hospitals. The intervention was conducted over a 6-month period aimed at increasing HPV vaccination rates through a nurse based protocol at one hospital (H-NBP) and an EMR postpartum order prompt at the second hospital (H-EMR). Outcomes measures included vaccine administration, patient refusal, and vaccine wastage. A multiple logistic regression model was used to compare outcomes. At H-NBP, 143 vaccine-eligible patients (74%) were identified of which 44 (32%) received the HPV vaccine, 66 (46%) refused, and 33 (21%) had missed opportunities. At H-EMR, 169 patients (87%) were identified as vaccine-eligible of which 111 (66%) received the HPV4 vaccine, 24 (14%) refused and 34 (20%) had missed opportunities. After adjusting for sociodemographic variables, patients at H-EMR were nearly 6 times more likely than patients at H-NBP to undergo postpartum HPV vaccination (OR 5.865, CI 3.358-10.245, p value < 0.0001). An EMR prompt offers a greater impact on HPV vaccination rates than a nursing protocol. The feasibility and success of inpatient postpartum HPV vaccination interventions as demonstrated in this study provides insights on how to approach vaccination strategies in nontraditional clinical settings.

Brief report: a qualitative analysis of discussions about HIV in families of parents with HIV.

OBJECTIVE: To explore communication about HIV prevention, risk behaviors, and transmission in families affected by HIV. METHODS: Semi-structured interviews were conducted with 33 parents with HIV, 27 children (9- to 17-years old), and 19 adult children (>or=18-years old) across the U.S. Coders reviewed transcripts, identified themes, and coded transcripts. RESULTS: Youth felt uncomfortable discussing HIV with their parent who has HIV because they worried about upsetting and reminding the parent of his/her illness. Adult children reported learning about HIV prevention by watching how the illness affected their parents. Few siblings reported talking with one another about HIV because they worried about upsetting their brother/sister and about their sibling unintentionally disclosing the parent's illness to others. CONCLUSIONS: Discussions between youth and their parent with HIV and their siblings vary, highlighting the need for further research in this area.