Reimbursement is barrier to offering HPV vaccine.

NEW ORLEANS -- Getting reimbursed is the top concern for physicians who offer the human papillomavirus vaccine, according to a survey conducted by researchers at Brigham and Women's Hospital, Boston.

Using a Web-based tool, Brigham resident Emily M. Ko and her colleagues surveyed 1,488 physicians who practiced with the Partners HealthCare System from May to July 2007. The survey included physicians practicing in tertiary and community settings.

Overall, 424 physicians participated. Of these, 196 (46%) were internists, 104 (25%) were pediatricians, and 87 (21%) were ob.gyns. The remainder came from various specialties, including infectious disease, geriatrics, endocrinology, and emergency medicine, Dr. Ko reported in a poster at the annual meeting of the American College of Obstetricians and Gynecologists.

Of those who participated, 80% said they offer the HPV vaccine. That included 92% of pediatricians, 81% of ob.gyns., and 78% of internists. According to the researchers, male physicians were 54% less likely to provide the vaccine than were female physicians. The survey did not ask questions that would determine why some physicians might be less likely to offer the vaccine, Dr. Ko said in an interview.

However, in citing barriers to vacci-nation, she noted that male physicians were six times more likely than female physicians to say that vaccination would keep patients from getting routine gynecologic exams or Pap smears.

Physicians based in community hospitals were twice as likely to offer the vaccine as were their colleagues at tertiary care facilities. Primary care physicians were 14 times more likely than were specialists to offer the shot.

Overall, survey participants cited reimbursement as the No. 1 hurdle to offering the vaccine.

In all, 95% of physicians said the vaccine would not promote promiscuity or decrease the use of condoms. Of the remainder, 3% were neutral on the issue, and 1.4% said that the vaccine might promote promiscuity, according to Dr. Ko.

There was no difference between genders or among specialties on the promiscuity issue. However, 7% of physicians said that vaccination would promote sexuality and promiscuity. This was not reported as one of the biggest barriers to vaccination, Dr. Ko said.

Dr. Ko reported no conflict of interest disclosures.

BY ALICIA AULT

Associate Editor, Practice Trends