Appl Clin Inform 2022; 13(01): 030-036
DOI: 10.1055/s-0041-1740484
Research Article

Pediatric Provider Utilization of a Clinical Decision Support Alert and Association with HIV Pre-exposure Prophylaxis Prescription Rates

Carrie T. Chan
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
,
Megen Vo
3  Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, United States
,
Jennifer Carlson
3  Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, United States
,
Tzielan Lee
4  Department of Pediatrics — Rheumatology, Stanford University School of Medicine, Palo Alto, California, United States
,
Marcello Chang
5  Stanford University School of Medicine, Stanford, California, United States
,
Geoffrey Hart-Cooper
6  Stanford Children's Health, Menlo Park, California, United States
› Institutsangaben

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.

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 Stanford University Institutional Review Board.




Publikationsverlauf

Eingereicht: 22. Juli 2021

Angenommen: 01. November 2021

Publikationsdatum:
12. Januar 2022 (online)

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany