Electronic Medical Record Prompting To Improve HPV Vaccination Rates

Electronic Medical Record Prompting To Improve HPV Vaccination Rates

Poster Abstracts / J Pediatr Adolesc Gynecol 30 (2017) 275e298 283 However, after adjusting for age, ethnicity, race, type of insurance, preferred l...

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Poster Abstracts / J Pediatr Adolesc Gynecol 30 (2017) 275e298

283

However, after adjusting for age, ethnicity, race, type of insurance, preferred language, clinic and sexual activity, the odds of immunization was only 33% higher in OB/GYN only patients after the EMR implementation than in patients before the implementation. Conclusion: Overall, the vaccination rates statistically improved in all of our clinics, however, only pediatric and family medicine clinics significantly improved after implementing the EMR pop-up prompt. Prompts in the electronic medical record are a low cost intervention for improving vaccination rates. Future directions include better tracking of vaccine status among patients in the EMR and further education of medical staff in order to promote vaccination to all eligible patients.

19. Pharmacy Access to the Emergency Contraceptive Ulipristal Acetate in Major Cities Throughout the United States

Fig 2. Types of IUDs.Ă

Conclusions: Theory based comics about IUD was valued by primary care providers who participated in our survey as a health education tool. We are conducting a pre-post study to evaluate its effect on women’s subjective knowledge about IUDs. We are in the process of developing comics for other birth control methods as well.

18. Electronic Medical Record Prompting To Improve HPV Vaccination Rates Laura C. Gutierrez MD, Christina G. Bracamontes MS, Jennifer Molokwu MD MPH, Maria T. Villanos MD, Melissa D. Mendez MD* Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas

Background: The human papilloma virus (HPV) vaccine can help reduce the number of HPV-associated cancer cases worldwide. Despite this fact, there has been a rise of HPV-associated cancers in the United States. This may be due to patient barriers including: lack of knowledge about HPV and its link to cervical cancer, and insurance status. Although it is still unknown what the best method is to increase vaccination compliance and vaccination rates, previous studies have shown that healthcare providers can influence acceptability of the vaccine. The objective of this study was to assess the effectiveness of an electronic medical record (EMR) prompt on HPV vaccination rates in the clinic setting. Methods: Inclusion criteria included: patients presenting at an academic clinic located along the Texas-Mexico border from January 2013 e December 2015 and males or females between the ages of 9 and 26. The baseline vaccination rate was assessed for Obstetrics & Gynecology (OB), Pediatrics, and Family Medicine clinics from January 2013 e December 2014. An educational session was provided for physicians in order to aid them in counseling women about the vaccine benefits. The prompt was introduced in EMR in January 2015 and vaccination rates were reassessed from January 2015 to December 2015. Data analysis was powered to 80% to detect a difference between group proportions using chi-squared test at 5% level of significance using a Logistic regression model with SAS V.9.4. Results: Over 2800 charts were reviewed. From the data collected, there was an increase in the percentage of HPV vaccination rates after implementing the prompt in all departments. In all three clinics, the odds of a patient being immunized were 74% higher in patients after the EMR popup prompt implementation, than in patients before the implementation. After adjusting for age, ethnicity, race, type of insurance, preferred language and clinic, the odds of immunization was 92% higher in patients after the EMR pop-up prompt implementation, than in patients before the implementation. For patients seen in the OB clinic alone, the odds of a patient being immunized were 94% higher in patients after the EMR prompt implementation than in patients before the implementation.

Maryssa Shigesato BA, Jennifer Elia DrPH, Mary Tschann MPH, PhD(c), Holly Bullock MD, MPH, Jennifer Salcedo MD, MPH, MPP* Department of Obstetrics, Gynecology & Women’s Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii

Background: Ulipristal acetate (UPA) is a selective progesterone receptor modulator approved in 2010 by the US Food and Drug Administration as a prescription emergency contraceptive to be taken within 120 hours of unprotected intercourse. Compared to levonorgestrel emergency contraceptive pills (LNG ECPs), UPA prevents more pregnancies when taken 1, 3 and 5 days after unprotected sex and may be more effective than LNG ECPs in overweight and obese women. Despite the potential for UPA to reduce the risk of unintended pregnancies after unprotected intercourse, its availability in pharmacies may be very limited. A recent study in Hawaii demonstrated less than 3% of pharmacies stocked UPA and less than 23% reported the ability to order it. Our study aimed to assess the availability of UPA in large cities nationwide. Methods: We conducted a telephone-based secret shopper study of 533 retail pharmacies sampled proportionally from ten large cities in four different geographic regions across the US (Denver, Seattle, Los Angeles, Detroit, Chicago, Philadelphia, Boston, Jacksonville, Charlotte, and Dallas) to evaluate the availability of UPA. Callers represented themselves as uninsured 18-year-old females attempting to fill a prescription for UPA. Using a semi-structured questionnaire, callers inquired regarding availability and use of UPA, as well as alternative ECPs available. Results: Of the 533 pharmacies sampled, 344 met inclusion criteria. Less than 10% of pharmacies indicated the ability to fill UPA immediately, while 72% of pharmacies reported the ability to order UPA, with an average wait time of 31.8 +/- 22.8 hours. There were no significant regional differences in immediate availability, however chain pharmacies were 3.8 times more likely to have UPA immediately available, and 3.4 times more likely to indicate an ability to order UPA, than independent pharmacies. In addition, there was a significant difference in the ability to order UPA between regions. Approximately 51% of pharmacy staff were able to provide correct information on how soon after unprotected sex UPA must be taken, while 64% were able to provide some correct information on differences between UPA and LNG ECPs. Pharmacists were four times more likely than other pharmacy staff to provide correct information on such medication differences. More than 81% of pharmacies reported immediate availability of ECPs other than UPA, of which 98.9% cited availability of Plan BÒ. Conclusions: Despite evidence for increased efficacy of UPA over LNG ECPs, the availability of UPA in US major cities is extremely limited. Patients do not reliably receive accurate information about UPA use, nor on differences between UPA and other ECPs. Given that ECPs should be taken as soon as possible after unprotected sex, the long wait times when ordering UPA are concerning. Efforts to improve the education of clinicians and pharmacists regarding the range of ECPs available and the important differences between them are needed to optimize the potential of ECPs to decrease unintended pregnancy following unprotected sex.