Saint Louis University School of Medicine, MO, USA.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231201784. doi: 10.1177/21501319231201784.
Preexposure Prophylaxis (PrEP) is under-utilized in primary care. Given differences in treatment approaches for other conditions between family medicine (FM) and general internal medicine (GIM), this study compared PrEP-prescribing between FM and GIM physicians.
De-identified electronic health record data from a multi-state health care system was used in this retrospective observational study. The time period from 1/1/13 to 9/30/21 was used to identify PrEP eligible patients using measures of current sexually transmitted disease and condomless sex at the time of eligibility. Receipt of PrEP was measured in the 12 months after PrEP eligibility. The odds of receiving PrEP in GIM as compared to FM was computed before and after adjusting for demographics and physical and psychiatric comorbidities.
The majority of eligible patients were 18 to 39 years of age, 60.9% were female and 71.6% were White race. Among PrEP eligible patients, 1.1% received PrEP in the first year after index date. Receiving PrEP was significantly more likely among patients treated in GIM versus FM (OR = 2.30; 95% CI:1.63-3.25). After adjusting for covariates, this association remained statistically significant (OR = 2.02; 95% CI:1.41-2.89).
PrEP is grossly under-utilized in primary care. The majority of Americans enter the health care system through primary care and not through HIV providers or other specialties. Therefore, educational interventions are needed to increase confidence and knowledge and to encourage PrEP prescribing by FM and GIM physicians.
暴露前预防（PrEP）在初级保健中的使用率较低。鉴于家庭医学（FM）和普通内科（GIM）在治疗其他疾病方面的方法存在差异，本研究比较了 FM 和 GIM 医生开具 PrEP 处方的情况。
本回顾性观察研究使用来自多州医疗保健系统的去识别电子健康记录数据。使用当前性传播疾病和符合资格时无保护性行为的措施，从 2013 年 1 月 1 日至 2021 年 9 月 30 日确定 PrEP 合格患者。在符合 PrEP 资格后的 12 个月内测量 PrEP 的使用情况。在调整人口统计学、身体和精神合并症后，计算 GIM 与 FM 相比接受 PrEP 的可能性。
大多数合格患者年龄在 18 至 39 岁之间，60.9%为女性，71.6%为白人。在 PrEP 合格患者中，有 1.1%的人在指数日期后的第一年接受了 PrEP。与 FM 相比，GIM 治疗的患者接受 PrEP 的可能性显著更高（OR=2.30；95%CI：1.63-3.25）。在调整协变量后，这种关联仍然具有统计学意义（OR=2.02；95%CI：1.41-2.89）。
PrEP 在初级保健中严重未得到充分利用。大多数美国人通过初级保健进入医疗保健系统，而不是通过 HIV 提供者或其他专业人员。因此，需要进行教育干预，以提高 FM 和 GIM 医生的信心和知识，鼓励他们开具 PrEP 处方。
