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Appl Clin Inform 2022; 13(05): 1141-1150
DOI: 10.1055/a-1975-4277
Research Article

Usability and Utility of Human Immunodeficiency Virus Pre-exposure Prophylaxis Clinical Decision Support to Increase Knowledge and Pre-exposure Prophylaxis Initiations among Pediatric Providers

Carrie T. Chan
1   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 Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States
,
Jennifer Carlson
4   Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California United States
,
Tzielan Lee
5   Department of Pediatrics—Rheumatology, Stanford University School of Medicine, Palo Alto, California, United States
,
Megen Vo
4   Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California United States
,
Annette Nasr
1   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
6   Department of Pediatrics-Gastroenterology, Stanford University School of Medicine, Palo Alto, California United States
,
Geoffrey Hart-Cooper
7   Stanford Children's Health, Menlo Park, California, United States
› Author Affiliations Funding This work was supported by the Stanford Nurse Alumnae Legacy Grant.
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Abstract

Objectives An effective clinical decision support system (CDSS) may address the current provider training barrier to offering preexposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV) infection. This study evaluated change in provider knowledge and the likelihood to initiate PrEP after exposure to a PrEP CDSS. A secondary objective explored perceived provider utility of the CDSS and suggestions for improving CDSS effectiveness.

Methods This was a prospective study using survey responses from a convenience sample of pediatric providers who launched the interruptive PrEP CDSS when ordering an HIV test. McNemar's test evaluated change in provider PrEP knowledge and likelihood to initiate PrEP. Qualitative responses on CDSS utility and suggested improvements were analyzed using framework analysis and were connected to quantitative analysis elements using the merge approach.

Results Of the 73 invited providers, 43 had available outcome data and were included in the analysis. Prior to using the CDSS, 86% of participants had never been prescribed PrEP. Compared to before CDSS exposure, there were significant increases in the proportion of providers who were knowledgeable about PrEP (p = 0.0001), likely to prescribe PrEP (p < 0.0001) and likely to refer their patient for PrEP (p < 0.0001). Suggestions for improving the CDSS included alternative “triggers” for the CDSS earlier in visit workflows, having a noninterruptive CDSS, additional provider educational materials, access to patient-facing PrEP materials, and additional CDSS support for adolescent confidentiality and navigating financial implications of PrEP.

Conclusion Our findings suggest that an interruptive PrEP CDSS attached to HIV test orders can be an effective tool to increase knowledge and likelihood to initiate PrEP among pediatric providers. Continual improvement of the PrEP CDSS based on provider feedback is required to optimize usability, effectiveness, and adoption. A highly usable PrEP CDSS may be a powerful tool to close the gap in youth PrEP access and uptake.

Keywords

clinical decision support - electronic health records - adolescent medicine - alert - order set - healthcare providers - pediatric health

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Stanford University Institutional Review Board.


Supplementary Material



Publication History

Received: 22 July 2022

Accepted: 15 October 2022

Accepted Manuscript online:
09 November 2022

Article published online:
08 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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