Carrie T Chan1,2, Megen Vo3, Jennifer Carlson3, Tzielan Lee4, Marcello Chang5, Geoffrey Hart-Cooper6. 1. Center for Adolescent Health, Lucile Packard Children's Hospital, Palo Alto, California, United States. 2. Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, United States. 3. Department of Pediatrics-Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, United States. 4. Department of Pediatrics - Rheumatology, Stanford University School of Medicine, Palo Alto, California, United States. 5. Stanford University School of Medicine, Stanford, California, United States. 6. Stanford Children's Health, Menlo Park, California, United States.
Abstract
OBJECTIVES: An electronic clinical decision support (CDS) alert can provide real-time provider support to offer pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV). The purpose of this study was to evaluate provider utilization of a PrEP CDS alert in a large academic-community pediatric network and assess the association of the alert with PrEP prescribing rates. METHODS: HIV test orders were altered for patients 13 years and older to include a hard-stop prompt asking if the patient would benefit from PrEP. If providers answered "Yes" or "Not Sure," the CDS alert launched with options to open a standardized order set, refer to an internal PrEP specialist, and/or receive an education module. We analyzed provider utilization using a frequency analysis. The rate of new PrEP prescriptions for 1 year after CDS alert implementation was compared with the year prior using Fisher's exact test. RESULTS: Of the 56 providers exposed to the CDS alert, 70% (n = 39) responded "Not sure" to the alert prompt asking if their patient would benefit from PrEP, and 54% (n = 30) chose at least one clinical support tool. The PrEP prescribing rate increased from 2.3 prescriptions per 10,000 patients to 6.6 prescriptions per 10,000 patients in the year post-intervention (p = 0.02). CONCLUSION: Our findings suggest a knowledge gap among pediatric providers in identifying patients who would benefit from PrEP. A hard-stop prompt within an HIV test order that offers CDS and provider education might be an effective tool to increase PrEP prescribing among pediatric providers. Thieme. All rights reserved.
OBJECTIVES: An electronic clinical decision support (CDS) alert can provide real-time provider support to offer pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV). The purpose of this study was to evaluate provider utilization of a PrEP CDS alert in a large academic-community pediatric network and assess the association of the alert with PrEP prescribing rates. METHODS: HIV test orders were altered for patients 13 years and older to include a hard-stop prompt asking if the patient would benefit from PrEP. If providers answered "Yes" or "Not Sure," the CDS alert launched with options to open a standardized order set, refer to an internal PrEP specialist, and/or receive an education module. We analyzed provider utilization using a frequency analysis. The rate of new PrEP prescriptions for 1 year after CDS alert implementation was compared with the year prior using Fisher's exact test. RESULTS: Of the 56 providers exposed to the CDS alert, 70% (n = 39) responded "Not sure" to the alert prompt asking if their patient would benefit from PrEP, and 54% (n = 30) chose at least one clinical support tool. The PrEP prescribing rate increased from 2.3 prescriptions per 10,000 patients to 6.6 prescriptions per 10,000 patients in the year post-intervention (p = 0.02). CONCLUSION: Our findings suggest a knowledge gap among pediatric providers in identifying patients who would benefit from PrEP. A hard-stop prompt within an HIV test order that offers CDS and provider education might be an effective tool to increase PrEP prescribing among pediatric providers. Thieme. All rights reserved.
Authors: Brian L Strom; Rita Schinnar; Faten Aberra; Warren Bilker; Sean Hennessy; Charles E Leonard; Eric Pifer Journal: Arch Intern Med Date: 2010-09-27
Authors: Kirk D Henny; Christopher C Duke; Angelica Geter; Zaneta Gaul; Chantell Frazier; Jennifer Peterson; Kate Buchacz; Madeline Y Sutton Journal: AIDS Behav Date: 2019-11
Authors: Norma S Harris; Anna Satcher Johnson; Ya-Lin A Huang; Dayle Kern; Paul Fulton; Dawn K Smith; Linda A Valleroy; H Irene Hall Journal: MMWR Morb Mortal Wkly Rep Date: 2019-12-06 Impact factor: 17.586