Department of Primary Care, Virginia Mason Medical Center, Seattle, Washington, USA.
Department of Medicine, Virginia Mason Medical Center, Seattle, Washington, USA.
BMJ Open Qual. 2022 May;11(2). doi: 10.1136/bmjoq-2021-001749.
Although emtricitabine-tenofovir was approved for HIV pre-exposure prophylaxis (PrEP) in 2012, use by persons at risk of acquiring HIV has been limited. Because many primary care providers lacked familiarity and comfort prescribing PrEP, at our institution PrEP prescribing was concentrated among the infectious disease specialists, effectively limiting access. This project sought to increase the number of patients receiving new prescriptions for PrEP. The interventions targeted primary care providers (including internal medicine and family medicine), and were designed to increase the number of unique providers offering PrEP to their patients. The overall strategy was to expand the clinical scope of practice for primary care providers through education and provision of detailed care templates in the electronic health record. These initiatives were implemented through a series of informal Plan-Do-Study-Act cycles, then generalised throughout the medical system. To evaluate the success of the project, we queried the electronic medical record for all new prescriptions for PrEP, with provider name and specialty, for all outpatients 18 years of age and older from 2012 through 2020. In 2015, prior to the intervention, only 78 patients received new prescriptions for PrEP at our institution, and only 38% (30 of 78) of these were from primary care clinicians. After the intervention, the number of patients receiving PrEP increased to 190 in 2019, with 85% (162 of 190) prescribed by primary care providers. In addition, the number of primary care providers making a new prescription for PrEP increased from 20 in 2015 to 73 in 2019. We conclude that targeted clinical education, combined with electronic health record templates, was associated with a significant increase in PrEP prescribing.
尽管恩曲他滨替诺福韦于 2012 年被批准用于 HIV 暴露前预防（PrEP），但有感染 HIV 风险的人使用它的情况受到限制。由于许多初级保健提供者对开 PrEP 处方缺乏熟悉和信心，我们机构的 PrEP 处方主要集中在传染病专家手中，这实际上限制了获得 PrEP 的机会。该项目旨在增加接受新的 PrEP 处方的患者人数。干预措施针对初级保健提供者（包括内科和家庭医学），旨在通过教育和在电子健康记录中提供详细的护理模板，增加提供 PrEP 的独特提供者的数量。总体策略是通过一系列非正式的计划-执行-研究-行动循环，扩大初级保健提供者的临床实践范围，然后将这些举措推广到整个医疗系统。为了评估项目的成功，我们查询了 2012 年至 2020 年期间所有 18 岁及以上的门诊患者的电子病历中所有新的 PrEP 处方的信息，包括提供者姓名和专业。在干预之前的 2015 年，我们机构只有 78 名患者接受了新的 PrEP 处方，其中只有 38%（78 名中的 30 名）是由初级保健临床医生开的。干预后，接受 PrEP 的患者人数在 2019 年增加到 190 人，其中 85%（190 名中的 162 名）由初级保健提供者开具。此外，开新的 PrEP 处方的初级保健提供者人数从 2015 年的 20 人增加到 2019 年的 73 人。我们得出结论，有针对性的临床教育，结合电子健康记录模板，与 PrEP 处方的显著增加有关。
