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Frequently Used Tools:




HPV Toolkit: Overcoming Access Issues and Barriers

HPV and STDs are a sensitive subject. How do I discuss HPV with adolescent patients and their parents?

  • Resources
  1. The Association of Women's Health, Obstetrics and Neonatal Nurses (AWHONN) has created a booklet guiding HPV counseling to young patients and their parents:
  2. Opening the Conversation - Talking with Teens in Your Office
  • While you may have to talk to adolescent patients one-on-one to get the information you need, avoid a tone that would devalue parental authority. Encourage young patients to communicate more openly with their parents so that both can be in agreement about prevention/treatment options. You can remain a confidante without siding against the parents.
  • Avoid minimizing parents' concerns about sexual activity, contraception, vaccination, etc. Though some concerns may seem irrational to you, help parents process these concerns in the interest of what is best for their child's health. Try to be respectful even when you disagree.
  • Help parents to be realistic about their children given current adolescent sex statistics. The more they understand the reality of the data, the more likely they will see the need for prevention.

I don't feel comfortable recommending a vaccine that my patients can't afford, will it be covered by insurance?

Currently, the HPV vaccine is covered by some, but not all, insurance programs. Efforts are underway to expand coverage and to increase state funding of the vaccine for those who would fall through the cracks, but this will take time. Patients with insurance and TennCare need to check to verify coverage. Patients under the age of 19 may qualify for the Vaccines for Children Program if they meet the following criteria:

  • Medicaid eligible (TennCare), American Indian, Alaska native or uninsured
  • Also possible to use this program if private insurance will not cover vaccinations but other criteria is met

If a patient does not qualify for assistance or their insurance doesn't cover the vaccine, and they don't want to pay for it out of pocket, encourage them that the price will likely drop if they have to wait to get the vaccine. A competitive product is expected to be introduced and pressure is building for insurance companies to expand coverage. Within time, there is a good chance that either the vaccine cost will be covered by their insurance and/or the out of pocket price will decrease.

Additional Information on Vaccine Assistance

How do I get my patients to return for all three shots?

  • Merck, the manufacturer of Gardasil, has created a Web site that allows patients to set up mail and email alerts to remind them about returning for follow-up appointments: http://www.gardasil.com/what-is-gardasil/3-is-Key/three-is-key/index.html
  • The main Merck Web site has a page on Gardasil geared specifically for healthcare professionals: https://www.merckvaccines.com/gardasilProductPage_frmst.html If you scroll down, there is a box on the right side that highlights the "3 is key" program. If you click on this box you will find several different suggestions for improving patient compliance with Gardasil, including:
    • Tear sheets that encourage the patient to sign-up for reminders for follow-up appointments
    • Chart stickers to record the date of the first shot and draw attention to the need for follow-up
    • Special Gardasil appointment cards that spell out when to return for the second and third doses.
    • Gardasil appointment reminder file- to keep up with necessary return visits.
  • Make it easy for patients to return for quick re-vaccination without a true "office-visit"
  • Write out prescriptions for the two follow-up shots allowing them to be administered by a pharmacist, avoiding follow-up appointments all together

Additional tips:

  • Be familiar with community-specific barriers to vaccination/ gynecological screening.
  • Think about your location. Could this be a barrier? (Ex: If you work at a health department, is it perceived as a normal doctor's office or an STD clinic?) Consider hosting a vaccine drive at a neutral public location.