According to a study, published in Applied Clinical Informatics, electronic clinical decision support (CDS) system alerts can improve the offering of pre-exposure prophylaxis (PrEP) to youth patients who are at risk for human immunodeficiency virus (HIV). Researchers, led by Carrie T. Chan, examined provider utilization of a PrEP CDS alert and associated PrEP prescribing rates, and observed what they called a “knowledge gap” in selection of patients who would benefit from PrEP among pediatric health care providers.

Working in a large academic-community pediatric network, the team altered HIV test orders for patients aged 13 years or older to include a hard-stop prompt asking if the patient would benefit from PrEP. If the providers answered “Yes” or “Not sure,” the CDS system then offered a standardized HIV order, a referral to an internal PrEP specialist, and/or an educational module. Frequency analysis was used to assess provider utilization, and Fisher’s exact test was used to compare prescribing rates in the one year period prior to and after the CDS alert implementation.

A total of 56 providers were served the CDS alert. Thirty-nine (70%) responded “Not sure” to the initial prompt, and 30 (54%) selected at least one of the clinical support tools. In the year after CDS implementation, the PrEP prescribing rate increased from 2.3 prescriptions to 6.6 prescriptions per 10,000 patients.

The study’s authors concluded that the implementation of CDS alerts appeared to improve the rate of PrEP prescriptions for young patients potentially at risk for HIV infection. They suggested that “a hard-stop prompt within an HIV test order that offers CDS and provider education might be an effective tool to increase PrEP prescribing among pediatric providers.”

Source: Applied Clinical Informatics