Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Intern Med. 2024 Oct 1;184(10):1204-1211. doi: 10.1001/jamainternmed.2024.3998.
Clinicians are a key component of preexposure prophylaxis (PrEP) care. Yet, no prior studies have quantitatively investigated how PrEP adherence differs by clinician specialty.
To understand the association between prescribing clinician specialty and patients not picking up (reversal/abandonment) their initial PrEP prescription.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of patients who were 18 years or older used pharmacy claims data from 2015 to 2019 on new insurer-approved PrEP prescriptions that were matched with clinician data from the US National Plan and Provider Enumeration System. Data were analyzed from January to May 2022.
Clinician specialties included primary care practitioners (PCPs), infectious disease (ID), or other specialties. Reversal was defined as a patient not picking up their insurer-approved initial PrEP prescription. Abandonment was defined as a patient who reversed and still did not pick their prescription within 365 days.
Of the 37 003 patients, 4439 (12%) were female and 32 564 (88%) were male, and 77% were aged 25 to 54 years. A total of 24 604 (67%) received prescriptions from PCPs, 3571 (10%) from ID specialists, and 8828 (24%) from other specialty clinicians. The prevalence of reversals for patients of PCPs, ID specialists, and other specialty clinicians was 18%, 18%, and 25%, respectively, and for abandonments was 12%, 12%, and 20%, respectively. After adjusting for confounding, logistic regression models showed that, compared with patients who were prescribed PrEP by a PCP, patients prescribed PrEP by ID specialists had 10% lower odds of reversals (odds ratio [OR], 0.90; 95% CI, 0.81-0.99) and 12% lower odds of abandonment (OR, 0.88; 95% CI, 0.78-0.98), while patients prescribed by other clinicians had 33% higher odds of reversals (OR, 1.33; 95% CI, 1.25-1.41) and 54% higher odds of abandonment (OR, 1.54; 95% CI, 1.44-1.65).
The results of this cross-sectional study suggest that PCPs do most of the new PrEP prescribing and are a critical entry point for patients. PrEP adherence differs by clinician specialties, likely due to the populations served by them. Future studies to test interventions that provide adherence support and education are needed.
临床医生是暴露前预防 (PrEP) 护理的关键组成部分。然而，以前没有研究定量调查 PrEP 依从性是否因临床医生的专业而不同。
了解开具 PrEP 处方的临床医生专业与患者未取药（逆转/放弃）其初始 PrEP 处方之间的关联。
设计、地点和参与者：本横断面研究使用了 2015 年至 2019 年的药房索赔数据，涉及新保险公司批准的 PrEP 处方，这些数据与来自美国国家计划和提供者登记系统的临床医生数据相匹配。数据于 2022 年 1 月至 5 月进行分析。
临床医生专业包括初级保健医生 (PCP)、传染病 (ID) 或其他专业。逆转定义为患者未取其保险公司批准的初始 PrEP 处方。放弃是指患者逆转且在 365 天内仍未取药。
在 37003 名患者中，4439 名（12%）为女性，32564 名（88%）为男性，77%年龄在 25 岁至 54 岁之间。共有 24604 名（67%）患者接受 PCP 开具的处方，3571 名（10%）患者接受 ID 专家开具的处方，8828 名（24%）患者接受其他专业临床医生开具的处方。PCP、ID 专家和其他专业临床医生开具的处方的逆转率分别为 18%、18%和 25%，放弃率分别为 12%、12%和 20%。在调整混杂因素后，逻辑回归模型显示，与接受 PCP 开具 PrEP 处方的患者相比，接受 ID 专家开具 PrEP 处方的患者逆转的可能性降低 10%（优势比 [OR]，0.90；95%CI，0.81-0.99），放弃的可能性降低 12%（OR，0.88；95%CI，0.78-0.98），而接受其他临床医生开具的处方的患者逆转的可能性增加 33%（OR，1.33；95%CI，1.25-1.41），放弃的可能性增加 54%（OR，1.54；95%CI，1.44-1.65）。
这项横断面研究的结果表明，PCP 开展了大部分新的 PrEP 处方开具工作，是患者的重要切入点。PrEP 依从性因临床医生专业而异，可能是因为他们所服务的人群不同。需要开展未来的研究来测试提供依从性支持和教育的干预措施。
