Patient Communication Strategies for Boosting HPV Vaccination Coverage

Pharmacists have long been considered among the most accessible and trusted health care advisors. In fact, in a recent Gallup survey, pharmacists ranked as the second most trusted group among a variety of professions. The high level of trust patients hold for their pharmacist is most likely the result of the ongoing nature of the relationship, with many patients seeing their pharmacist monthly.¹ Over the last decade, community pharmacists have leveraged this position and taken on a greater role in the health care spectrum.

One area in which pharmacists are well positioned to offer support is in the provision of immunizations. Most community pharmacies already offer influenza, pneumonia, shingles, and a variety of other immunizations according to demographics and need. Some even offer travel medicine clinics and have collaborative practice relationships, allowing pharmacists to collect, assess, and deliver vaccines as recommended based on the specific trip each patient may be taking.

HPV and the Pharmacist

A newer immunization offering that community pharmacists have begun to support is for prevention of the human papillomavirus (HPV). Unfortunately, HPV is fairly common and can infect both men and women. It has been shown to cause cervical cancer, which is the second leading cause of cancer deaths among women. HPV is also associated with less common cancers, such as vaginal and vulvar cancers in women, and anal and throat cancer in both men and women.²

Expanding access to the vaccine is a huge win for health care, as we can potentially reduce the spread of HPV and its associated long-term complications, such as cervical cancer. By providing this vaccine at community pharmacies, we can simplify and reduce barriers to access, leading to increased utilization of the vaccine, and ultimately support cancer prevention in the community. The target population for the vaccine is individuals 19 to 26 years of age, many of whom only see their physician once a year and who may not grasp its importance. Community pharmacists are positioned to interact with these patients during everyday pharmacist/patient consultations. These patients also typically are more apt to come in for influenza vaccinations due to comfort with personal education about the flu shot. This represents a good opportunity to educate the patient about HPV vaccines.

As pharmacies continue to add services such as HPV immunizations, the pharmacist should establish deep relationships with other health care providers in our community. These relationships enable us to function as true partners in caring for patients and create a collaboration focused on increasing vaccination rates in the community.

Patient Engagement: Challenges and Strategies

One of the initial barriers to starting an HPV immunization program is deciding how best to engage with eligible patients. This initial conversation can be delicate, so having a good understanding of the advantages, risks, and potential concerns of the patient is important. Since we are usually starting from a point of strong relationship, we can leverage that credibility alongside our expertise in medications.

Most patients are not aware initially of the seriousness of HPV and its associated risks. Anchoring the conversation around cancer prevention is one of the best ways to increase patient interest in receiving the vaccine. Also, providing clear, simple information on the potential risks and benefits is crucial, because patients typically want more information before deciding on the vaccination. Leveraging pharmacist/patient interactions during the counseling process and consistently discussing HPV risks can lead to increased vaccinations. As part of this, we lay out the vaccine schedule and ensure the patient understands the full picture as well as their responsibilities through the series of injections.

Patients who decide to receive the HPV vaccination can have their first dose administered at that time. Often, the initial discussion does not lead to immunization; however, we can send our patients home with additional HPV information to review. By helping them understand the full picture, we gain commitment to complete the full series. Additionally, pharmacists should make a commitment to support patients and remind them about due dates. In today’s health care team approach, we have a unique opportunity to stay connected with patients using our medication synchronizations service to conduct mini comprehensive medication reviews on subsequent visits to help ensure positive immunization outcomes and series completions. Educating all patients about the services we provide is a continuous process and builds over time.

Patients who are asymptomatic represent a challenge in immunization. In target patients (19 to 26 years old), the HPV vaccine is administered in a 3-dose schedule at 0, 2, and 6 months. Insurance coverage varies, but many plans cover all vaccinations under preventive care. For patients who do not have insurance, the cost for all 3 administrations is affordable. When discussing the value of the vaccine, patients often account for the fact that an office visit is not needed for vaccinations, nor is a scheduled appointment. It is also important to have a professional, private area to administer immunizations to better reflect a clinic setting in which patients are comfortable. Patients take all of these factors into consideration when making a commitment to the series.

At the pharmacist level, time is always a challenge when providing additional services. Successful teams are well trained in all aspects of workflow and administrative requirements when immunizing. If possible, integrating immunizations into your workflow by maximizing the technician capabilities and talent around you may represent the best approach.

Conclusion

Increasing patient acceptance of vaccines presents unique opportunities for pharmacists. As trusted health care resources playing an important role in the evolving continuum of patient care, it is essential that we educate patients on the safety and efficacy of the HPV vaccine. Moreover, consistently discussing HPV immunizations may help to increase immunization rates. Ultimately, our approach to immunizations should not differ from assuring adherence to any medication therapy: we want to increase healthy outcomes and deliver the best care for our patients.

Ray Glaser, PharmD, is chief pharmacist at Thrifty White Pharmacy in Alexandria, Minnesota.

References

• Americans Rate Healthcare Providers High on Honesty, Ethics. Gallup poll. Dec 19, 2016. http://news.gallup.com/poll/200057/americans-rate-healthcare-providers-high-honesty-ethics.aspx. Accessed February 15, 2018.
• The Centers for Disease Control and Prevention. HPV Vaccine Information Sheet (VIS). CDC website. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv.html. Accessed February 15, 2018.