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Research ArticleOriginal Research

US Primary Care Physicians’ Viewpoints on HPV Vaccination for Adults 27 to 45 Years

Laura P. Hurley, Sean T. O’Leary, Lauri E. Markowitz, Lori A. Crane, Jessica R. Cataldi, Michaela Brtnikova, Brenda L. Beaty, Carol Gorman, Elissa Meites, Megan C. Lindley and Allison Kempe
The Journal of the American Board of Family Medicine January 2021, 34 (1) 162-170; DOI: https://doi.org/10.3122/jabfm.2021.01.200408
Laura P. Hurley
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
MD, MPH
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Sean T. O’Leary
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
MD, MPH
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Lauri E. Markowitz
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
MD
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Lori A. Crane
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
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Jessica R. Cataldi
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
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Michaela Brtnikova
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
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Brenda L. Beaty
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
MSPH
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Carol Gorman
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
BA
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Elissa Meites
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
MD, MPH
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Megan C. Lindley
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
MPH
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Allison Kempe
From Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO (LPH, STO, LAC, JRC, MB, BLB, CG, AK); Division of General Internal Medicine, Denver Health, Denver, CO (LPH); Department of Pediatrics, Children’s Hospital–Colorado, Aurora, CO (STO, JRC, MB, AK); National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (LEM, EM, MCL); Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO (LAC).
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    Figure 1.

    Anticipated changes in physician practice following ACIP recommendation for SCDM regarding HPV vaccination of adults 27 to 45 years, United States, 2019 to 2020 (n = 534). Abbreviations: ACIP, Advisory Committee on Immunization Practices; SCDM, shared clinical decision making; HPV, Human Papillomavirus.

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    Table 1.

    Demographic and Practice Characteristics of Survey Respondents and Non-Respondents, United States, 2019-2020 (n = 968)

    CharacteristicRespondents (n = 617)Non-Respondents (n = 351)P-Value
    Mean (SD) physician age, years54.8 (9.4)56.7 (9.1).002*†
    Female, %5038< .001*
    Specialty, %
     Family physician5439< .001*
     General internist4661
    Region of the United States, %
     Midwest2426.08
     Northeast1921
     South3336
     West2417
    Location of practice, %
     Urban2723.19
     Suburban6768
     Rural69
    Practice setting, %‡
     Private practice6678< .001*
     Hospital or clinic2517
     Health maintenance organization95
    Median (IQR) number of providers in practice6 (3 to 12)5 (2 to 10).002*§
    Decisions are made about purchasing and handling vaccines, %
     Independently5357.28
     At a larger system level4743
    • IQR, interquartile range; SD, standard deviation.

    • ↵* Bold values indicate statistical significance P < .05 between respondents and non-respondents.

    • † t-test used.

    • ↵‡ Numbers may not add to 100% due to rounding.

    • § Wilcoxon test used.

    • View popup
    Table 2.

    Physician Knowledge of HPV Disease and HPV Vaccination, United States, 2019 to 2020 (n = 617)

    Knowledge Concept: True or False?Correct AnswerPhysicians Answering Correctly (%)Physicians Answering Incorrectly (%)Physicians Answering, “Don’t Know” (%)
    Adults who have a new sex partner are at risk of acquiring a new HPV infectionTrue9613
    ACIP recommends against 9vHPV in unvaccinated adults age 27 through 45 years who have had multiple sex partnersFalse701119
    People who started the HPV vaccination series with an older vaccine can complete the series with 9vHPV*True65630
    HPV antibody testing is recommended for adults age 27 through 45 years as a part of shared clinical decision making for HPV vaccinationFalse641323
    Full HPV vaccination of an adult who started the series as an adult will require three doses of 9vHPV*True562124
    ACIP recommends against 9vHPV in unvaccinated adults age 27 through 45 years who have had a diagnosed HPV infectionFalse551035
    HPV vaccine prevents progression of existing HPV related cancersFalse451738
    HPV vaccine prevents progression of existing HPV infectionFalse382241
    HPV vaccine effectiveness is lower for adults age 27 through 45 years compared to adults age 18 through 26 yearsTrue303041
    Studies show that HPV vaccine is very effective in adults age 27 through 45 years with HIV infectionFalse83756
    • Some percentages do not add up to 100% because of rounding.

    • ↵* P ≤ .05 for statistical differences between specialties. Seventy-one percent of FP and 57% of GIM answered correctly that when HPV vaccination series was started with an older vaccine, it can be completed with 9vHPV. Fifty-nine percent of FP and 51% of GIM were aware that when HPV vaccination started as an adult requires 3 doses.

    • HPV, Human Papillomavirus; ACIP, Advisory Committee on Immunization Practices; HIV, human immunodeficiency virus.

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The Journal of the American Board of Family     Medicine: 34 (1)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 1
January/February 2021
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US Primary Care Physicians’ Viewpoints on HPV Vaccination for Adults 27 to 45 Years
Laura P. Hurley, Sean T. O’Leary, Lauri E. Markowitz, Lori A. Crane, Jessica R. Cataldi, Michaela Brtnikova, Brenda L. Beaty, Carol Gorman, Elissa Meites, Megan C. Lindley, Allison Kempe
The Journal of the American Board of Family Medicine Jan 2021, 34 (1) 162-170; DOI: 10.3122/jabfm.2021.01.200408

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US Primary Care Physicians’ Viewpoints on HPV Vaccination for Adults 27 to 45 Years
Laura P. Hurley, Sean T. O’Leary, Lauri E. Markowitz, Lori A. Crane, Jessica R. Cataldi, Michaela Brtnikova, Brenda L. Beaty, Carol Gorman, Elissa Meites, Megan C. Lindley, Allison Kempe
The Journal of the American Board of Family Medicine Jan 2021, 34 (1) 162-170; DOI: 10.3122/jabfm.2021.01.200408
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