Pickel Julia, Fiks Alexander G, Karavite Dean, Maleki Pegah, Beidas Rinad S, Dowshen Nadia, Petsis Danielle, Gross Robert, Wood Sarah M
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Clinical Futures and the Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Implement Sci Commun. 2023 Feb 21;4(1):18. doi: 10.1186/s43058-023-00394-7.
Clinical decision support (CDS) is a promising intervention for improving uptake of HIV testing and pre-exposure prophylaxis (PrEP). However, little is known regarding provider perspectives on acceptability, appropriateness, and feasibility of CDS for HIV prevention in pediatric primary care, a key implementation setting.
This was a cross-sectional multiple methods study utilizing surveys and in-depth interviews with pediatricians to assess acceptability, appropriateness, and feasibility of CDS for HIV prevention, as well as to identify contextual barriers and facilitators to CDS. Qualitative analysis utilized work domain analysis and a deductive coding approach grounded in the Consolidated Framework of Implementation Research. Quantitative and qualitative data were merged to develop an Implementation Research Logic Model to conceptualize implementation determinants, strategies, mechanisms, and outcomes of potential CDS use.
Participants (n = 26) were primarily white (92%), female (88%), and physicians (73%). Using CDS to improve HIV testing and PrEP delivery was perceived as highly acceptable (median score 5), IQR [4-5]), appropriate (5, IQR [4-5]), and feasible (4, IQR [3.75-4.75]) using a 5-point Likert scale. Providers identified confidentiality and time constraints as two key barriers to HIV prevention care spanning every workflow step. With respect to desired CDS features, providers sought interventions that were integrated into the primary care workflow, standardized to promote universal testing yet adaptable to the level of a patient's HIV risk, and addressed providers' knowledge gaps and bolstered self-efficacy in providing HIV prevention services.
This multiple methods study indicates that clinical decision support in the pediatric primary care setting may be an acceptable, feasible, and appropriate intervention for improving the reach and equitable delivery of HIV screening and PrEP services. Design considerations for CDS in this setting should include deploying CDS interventions early in the visit workflow and prioritizing standardized but flexible designs.
临床决策支持（CDS）是一种很有前景的干预措施，可提高艾滋病毒检测和暴露前预防（PrEP）的接受率。然而，对于在儿科初级保健这一关键实施环境中，提供者对CDS用于艾滋病毒预防的可接受性、适宜性和可行性的看法，我们了解甚少。
这是一项采用多种方法的横断面研究，通过对儿科医生进行调查和深入访谈，以评估CDS用于艾滋病毒预防的可接受性、适宜性和可行性，并确定CDS的背景障碍和促进因素。定性分析采用工作领域分析和基于实施研究综合框架的演绎编码方法。将定量和定性数据合并，以建立一个实施研究逻辑模型，将潜在CDS使用的实施决定因素、策略、机制和结果概念化。
参与者（n = 26）主要为白人（92%）、女性（88%）和医生（73%）。使用5分李克特量表，使用CDS改善艾滋病毒检测和PrEP的提供被认为是高度可接受的（中位数得分5，四分位间距[4 - 5]）、适宜的（5，四分位间距[4 - 5]）和可行的（4，四分位间距[3.75 - 4.75]）。提供者将保密性和时间限制确定为贯穿每个工作流程步骤的艾滋病毒预防护理的两个关键障碍。关于所需的CDS功能，提供者寻求能够整合到初级保健工作流程中的干预措施，这些措施标准化以促进普遍检测，但又能适应患者的艾滋病毒风险水平，并解决提供者的知识差距，增强其提供艾滋病毒预防服务的自我效能。
这项采用多种方法的研究表明，儿科初级保健环境中的临床决策支持可能是一种可接受、可行且适宜的干预措施，可提高艾滋病毒筛查和PrEP服务的覆盖范围及公平提供。在此环境中CDS的设计考虑应包括在就诊工作流程早期部署CDS干预措施，并优先考虑标准化但灵活的设计。
