1. National Immunization Partnership with the Academic Pediatric Association (NIPA) CDC Grant # 1H23IP000950

2. Agenda Office Systems Inventory: Practice Barriers Practice Strategies QI Strategies Any questions?

3. Practice Barriers

4. Which THREE affect your practice’s delivery of HPV vaccine most significantly?* *from the Office Systems Inventory **Aggregate data includes CORNET and NIPN sites **

5. *from the Office Systems Inventory CORNET Practice Barriers*

6. Parental Refusal, Parental Hesitation, Deferral

7. Parental refusal – who accepts? Front office Should have a positive and re-directive sentence to use “All vaccines are important, the nurse can tell you if your daughter is due for a shot today” Should have some information to give out – “Here is a brochure about adolescent/childhood vaccines” Should not comment on need for immunization Should not express any agreement (implicit or explicit) with a parent who is considering refusal.

8. Parental refusal – who accepts? Nurses Should tell the patient and the parent what vaccines are due and, if standing orders are present, administer those vaccines Should be supportive of all vaccines and treat them all equally including in how she presents them “today you are due for MCV, HPV and Tdap” Should discuss vaccines as she/he feels comfortable Should not accept a refusal “the doctor will want to discuss these vaccines with you”

9. Parental refusal – who accepts? Doctors Should discuss vaccine with the parent if the parent wants to discuss them “what information can I give you about the vaccines?” or “I’m your doctor, you come to me because you trust me, tell me your concerns” Should be brief and probe for needed additional information “the vaccine is safe, what concerns do you have about safety?” Should not accept refusal as final – “I hear your concerned, lets talk about this again at the next visit”

10. Prompts, Standing Orders, Reminder-Recall

12. Please contact: Nui Dhepyasuwan, MEd Phone: 703/556 9222 x103 I Fax: 703/556 8729 Email: nui@academicpeds.orgnui@academicpeds.org Holly Tyrrell, MSSW Phone: 703/556 9222 x113 I Fax: 703/556 8729 Email: hollyce@academicpeds.orghollyce@academicpeds.org