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Sternjakob-Marthaler A, Berkó-Göttel B, Rissland J, Schöpe J, Taurian E, Müller H, Weber G, Lohse S, Lamberty T, Holleczek B, Stoffel H, Hauptmann G, Giesen M, Firk C, Schanzenbach A, Brandt F, Hohmann H, Werthner Q, Selzer D, Lehr T, Wagenpfeil S, Smola S. Human papillomavirus vaccination of girls in the German model region Saarland: Insurance data-based analysis and identification of starting points for improving vaccination rates. PLoS One 2022; 17:e0273332. [PMID: 36054196 PMCID: PMC9439211 DOI: 10.1371/journal.pone.0273332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 08/07/2022] [Indexed: 11/18/2022] Open
Abstract
In Germany, the incidence of cervical cancer, a disease caused by human papillomaviruses (HPV), is higher than in neighboring European countries. HPV vaccination has been recommended for girls since 2007. However, it continues to be significantly less well received than other childhood vaccines, so its potential for cancer prevention is not fully realized. To find new starting points for improving vaccination rates, we analyzed pseudonymized routine billing data from statutory health insurers in the PRÄZIS study (prevention of cervical carcinoma and its precursors in women in Saarland) in the federal state Saarland serving as a model region. We show that lowering the HPV vaccination age to 9 years led to more completed HPV vaccinations already in 2015. Since then, HPV vaccination rates and the proportion of 9- to 11-year-old girls among HPV-vaccinated females have steadily increased. However, HPV vaccination rates among 15-year-old girls in Saarland remained well below 50% in 2019. Pediatricians vaccinated the most girls overall, with a particularly high proportion at the recommended vaccination age of 9–14 years, while gynecologists provided more HPV catch-up vaccinations among 15-17-year-old girls, and general practitioners compensated for HPV vaccination in Saarland communities with fewer pediatricians or gynecologists. We also provide evidence for a significant association between attendance at the children´s medical check-ups “U11” or “J1” and HPV vaccination. In particular, participation in HPV vaccination is high on the day of U11. However, obstacles are that U11 is currently not financed by all statutory health insurers and there is a lack of invitation procedures for both U11 and J1, resulting in significantly lower participation rates than for the earlier U8 or U9 screenings, which are conducted exclusively with invitations and reminders. Based on our data, we propose to restructure U11 and J1 screening in Germany, with mandatory funding for U11 and organized invitations for HPV vaccination at U11 or J1 for both boys and girls.
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Affiliation(s)
| | | | - Jürgen Rissland
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Jakob Schöpe
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg, Germany
| | - Emeline Taurian
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Hanna Müller
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Gero Weber
- Physical Geography and Environmental Research, Saarland University, Saarbrücken, Germany
| | - Stefan Lohse
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Thomas Lamberty
- Ministry of Health, Social Affairs, Women and the Family, Saarbrücken, Germany
| | - Bernd Holleczek
- Ministry of Health, Social Affairs, Women and the Family, Saarbrücken, Germany
- Saarland Cancer Registry, Saarbrücken, Germany
| | - Harry Stoffel
- Kassenärztliche Vereinigung Saarland, Saarbrücken, Germany
| | | | | | | | | | | | | | - Quirin Werthner
- Clinical Pharmacy, Saarland University, Saarbrücken, Germany
| | - Dominik Selzer
- Clinical Pharmacy, Saarland University, Saarbrücken, Germany
| | - Thorsten Lehr
- Clinical Pharmacy, Saarland University, Saarbrücken, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research, Saarbrücken, Germany
- * E-mail:
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Filippopulos FM, Huppert D, Brandt T, Hermann M, Franz M, Fleischer S, Grill E. Computerized clinical decision system and mobile application with expert support to optimize management of vertigo in primary care: study protocol for a pragmatic cluster-randomized controlled trial. J Neurol 2020; 267:45-50. [PMID: 32719973 PMCID: PMC7718197 DOI: 10.1007/s00415-020-10078-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
Vertigo and dizziness are amongst the most common symptoms in medicine and often have a major impact on activities of daily life. Although many causes of vertigo and dizziness can easily be recognized, patients often receive inappropriate and ineffective treatment. The reasons for this are various. Because vertigo/dizziness is an interdisciplinary symptom and there is a lack of standardised diagnostic tools, it is easy to lose the overview of the possible differential diagnoses. There is evidence though, that the management of patients with vertigo/dizziness can be optimized using standardized care pathways with digital support. The present study (within the framework of “PoiSe—prevention, online feedback, and interdisciplinary therapy of acute vestibular syndromes by e-health”) aims to evaluate the implementation of a program with several interlocking components. The three main components are a computerized clinical decision system, a mobile application, a counselling and interdisciplinary educational program developed by the German Center for Vertigo and Balance Disorders (DSGZ). The study is a cluster-randomized controlled trial with a parallel-group design, as well as a detailed process evaluation. Clusters comprise of primary care physician practices in Bavaria, Germany. In the scope of the study the effectiveness, acceptability and efficiency of the intervention will be evaluated. It is anticipated that the intervention will improve the quality and efficiency of the management of dizzy patients. A higher diagnostic accuracy, optimized treatment, and disease progression monitoring is expected to improve patient-relevant outcomes and reduce health-care costs.
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Affiliation(s)
- Filipp M Filippopulos
- German Center for Vertigo and Balance Disorders, LMU Klinikum, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany.
- Department of Neurology, LMU Klinikum, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany.
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, LMU Klinikum, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, LMU Klinikum, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany
| | - Margit Hermann
- AOK Bayern, Die Gesundheitskasse, Carl-Wery-Straße 28, 81739, Munich, Germany
| | - Mareike Franz
- Kassenärztliche Vereinigung Bayerns, Referat Versorgungsinnovationen, Elsenheimerstraße 39, 80687, Munich, Germany
| | - Steffen Fleischer
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Eva Grill
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians Universität, Marchioninistraße 15, 81377, Munich, Germany
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