Simple and Elaborated Clinician Reminder Prompts for Human Papillomavirus Vaccination: A Randomized Clinical Trial

Acad Pediatr. 2018 Mar;18(2S):S66-S71. doi: 10.1016/j.acap.2017.11.002.


Objective: To evaluate the effects of simple and elaborated health care provider (HCP) reminder prompts on human papillomavirus (HPV) vaccine initiation rates.

Methods: Twenty-nine pediatric HCPs serving 5 pediatric clinics were randomized to 1 of 3 arms: 1) usual practice control, 2) simple reminder prompt, and 3) elaborated reminder prompt, which included suggested language for recommending the early adolescent platform vaccines. Prompts were delivered via a computer-based clinical decision support system deployed in the 5 clinics. Eligible patients were ages 11 to 13 years, had not received HPV vaccine, and were due for meningococcal ACWY (MenACWY) vaccine and/or the tetanus, diphtheria, and pertussis booster (Tdap). Receipt of HPV vaccine was determined via automated queries sent to the Indiana immunization registry. Data were analyzed via logistic regression models, with generalized estimating equations used to account for the clustering of patients within HCPs.

Results: Ten HCPs in the control group saw 301 patients, 8 HCPs in the simple prompt group saw 124, and 11 HCPs in the elaborated prompt group saw 223. The elaborated prompt arm had a higher rate of HPV vaccination (62%) than the control arm (45%): adjusted odds ratio, 2.76; 95% confidence interval, 1.07 to 7.14. The simple prompt arm did not differ significantly from the control arm with respect to HPV vaccine initiation, which might have been because of the small sample size for this arm. MenACWY and Tdap rates did not vary across the 3 arms.

Conclusions: Results suggest that an elaborated HCP-targeted reminder prompt, with suggested recommendation language, might improve rates of HPV vaccine initiation.

Keywords: adolescent immunization; computer decision support; human papillomavirus; provider prompt.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Communication*
  • Decision Support Systems, Clinical*
  • Diphtheria / prevention & control
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / therapeutic use
  • Female
  • Humans
  • Logistic Models
  • Male
  • Meningococcal Infections / prevention & control
  • Meningococcal Vaccines / therapeutic use
  • Multivariate Analysis
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / therapeutic use*
  • Physician-Patient Relations
  • Tetanus / prevention & control
  • Vaccines, Conjugate / therapeutic use
  • Whooping Cough / prevention & control


  • Diphtheria-Tetanus-acellular Pertussis Vaccines
  • MenACWY
  • Meningococcal Vaccines
  • Papillomavirus Vaccines
  • Vaccines, Conjugate