PRP063: Preliminary results of HIV PrEP Order Set Implementation and Evaluation of Provider Knowledge and Prescription Habits

Rensa Chen, DO; Jared Roberts; Jessica Parascando; Jarrett Sell, MD, FAAFP, AAHIVS

Abstract

Context: There is a lack of provider knowledge, prescription and education of Pre-exposure prophylaxis (“PrEP”), a combination of medications designed to prevent human immunodeficiency virus (HIV) infection in high-risk populations. Currently, Penn State College of Medicine (PSCOM) has a standard set of labs required to start a patient on PrEP. However, educational outreach and a lab order set providing a checklist of labs for providers when prescribing PrEP may facilitate barriers to prescribing PrEP, such as lack of resources, comfort and personal beliefs about HIV prevention. Objective: To improve HIV prevention care to patients through provider education of PrEP (educational talks, pamphlets), implementation of a PrEP order set, and pre- and post-implementation assessment of provider PrEP knowledge and prescription habits. Study Design and Analysis: Pre/post survey study. Setting: Medical providers at PSCOM. Population: Providers in the departments of Family and Community Medicine and Internal Medicine at PSCOM (n=279). Instrument: REDCap survey includes Likert scale questions adapted from PCP PrEP Survey (Balckstock et al. 2016) assessing provider knowledge, comfort, and prescription habits of PrEP. Outcome Measures: Provider knowledge, comfort, and prescription habits of PrEP. Results: 133 providers completed the pre-survey (47.7% response rate; mean age 37.9 years; 52.6% Female). Over 50% of providers reported “Very Good” or “Excellent” overall knowledge of HIV PrEP, but were less confident in their knowledge of lab testing. Those more recently medically trained had higher levels of comfort and significantly higher levels of knowledge with PrEP utilization (p=.001). While providers most highly rated training/education as a barrier, an EMR order set was rated most highly for facilitating PrEP prescribing. Providers 5-10 years after training perceived the greatest knowledge, while providers more than 20 years outside of their training had the greatest perceived comfort with PrEP usage. Non-PrEP prescribers perceived more barriers and less facilitators, and responses from this group suggest the most effective way to increase PrEP usage was the utilization of a lab order set integrated into the EMR. Expected Outcomes: We anticipate that post-intervention providers will self-report an increase in PrEP knowledge, comfort and prescribing of PrEP. We anticipate non-PrEP prescribers to show the greatest increase in knowledge, comfort, and PrEP utilization.
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Diane Harper
harperdi@med.umich.edu 11/21/2021

Thank you so much for this research. It seems during COVID that we have forgotten that we are still in an HIV/AIDS pandemic with no vaccine development and relying solely on daily medicines for prevention. Thank you for sharing with us at NAPCRG.

Rensa Chen
rchen2@pennstatehealth.psu.edu 11/22/2021

Absolutely, agreed. Thanks so much for stopping by our poster!

Jack Westfall
jwestfall@aafp.org 11/22/2021

Such an important topic. PrEP is a real live saving intervention and more primary care practices need to know about it and how to do it. thanks for your work, your research and for sharing it at NAPCRG.

Rensa Chen
rchen2@pennstatehealth.psu.edu 11/22/2021

Appreciate you taking time to look at our research!

Mack Ruffin
mruffin@pennstatehealth.psu.edu 11/23/2021

Another great team effort. Thank you. I hypothesized the integrated lab order set would have made a bigger impact. Is the use of the lab set have extra steps that clinicians must do to bring it into their work flow or view? January's Department meeting as professional development sessions in break-out groups. This topic would fit nicely into a 30 minute breakout session. Contact Dr. Rabago.

Rensa Chen
rchen2@pennstatehealth.psu.edu 11/24/2021

Thanks for taking a look at our project Dr. Ruffin! The order set should be relatively simple to find. Providers can search in the order tab 'FCM HIV' or 'FCM Prep' and the order set immediately shows up. Thanks for the suggestion, I'll bring it up to our team!

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