Understanding HIV Pre-Exposure Prophylaxis Questions of U.S. Health Care Providers: Unique Perspectives from the PrEPline Clinical Teleconsultation Service.
Understanding HIV Pre-Exposure Prophylaxis Questions of U.S. Health Care Providers: Unique Perspectives from the PrEPline Clinical Teleconsultation Service.
复制标题
了解美国医疗保健提供者的 HIV 暴露前预防问题：PrEPline 临床远程咨询服务的独特视角。
DOI：
10.1089/tmj.2022.0145
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Chu,Carolyn
中科院分区：
文献类型：
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作者：
Saberi,Parya;Mehtani,NickyJ;Sayegh,Anthony;Camp,ChristinaElizabeth;Chu,Carolyn
在美国，只有不到四分之一的人被认为有与艾滋病毒感染相关的因素，他们得到了暴露前预防（PrEP）的处方。先前的研究表明，提供者在PrEP方面的舒适度和知识方面存在差异，这表明需要进行提供者能力建设，以支持PrEP的广泛使用。本研究调查了来自远程咨询服务提供者的实际PrEP临床问题/病例，以确定知识差距并改进与PrEP相关的培训材料和临床指南。方法：国家临床医生咨询中心（NCCC） PrEPline为美国卫生保健提供者提供与PrEP相关的临床决策教育远程咨询服务。对2017年至2020年收集的NCCC PrEP咨询数据进行了回顾，并按临床主题、子主题和复杂性水平（低、中、高）进行了系统分类。结果：在研究期间，PrEPline提供了1754次远程咨询。超过四分之三来自高级执业护士和医生。问题的主题通常集中在基于药物的艾滋病毒预防策略（22.7%），PrEP实验室订购/监测（17.4%）和副作用和禁忌症（14.6%）。大多数远程咨询（57.9%）涉及共享可直接获得/在疾病控制和预防中心（CDC） 2017年PrEP指南中处理的信息（即低复杂性）。讨论：来自非医师和非执业护士的低频率咨询可能表明需要增加对其他类型提供者的培训和合作机会。低复杂性查询的高比例可能表明需要专门为实践提供者设计的能力建设材料（例如，准则的节略版本）。这项研究可以为未来的研究、最佳临床实践提供信息，并有助于开发培训材料，以增加提供者对艾滋病毒预防的舒适度和知识。
Introduction:Fewer than a quarter of people considered to have factors associated with HIV acquisition are prescribed pre-exposure prophylaxis (PrEP) in the United States. Prior studies demonstrate disparities in provider comfort and knowledge regarding PrEP, suggesting a need for provider capacity building to support widespread PrEP availability. This study examined real-world PrEP clinical questions/cases from providers to a teleconsultation service to identify knowledge gaps and improve PrEP-related training materials and clinical guidelines.Methods:The National Clinician Consultation Center (NCCC) PrEPline provides educational teleconsultation services on clinical decision-making related to PrEP for U.S. health care providers. The NCCC PrEP consultation data collected between 2017 and 2020 were reviewed and systematically categorized by clinical topics, subtopics, and complexity levels (low, moderate, and high).Results:Within the study period, the PrEPline provided 1,754 teleconsultations. More than three quarters came from advanced practice nurses and physicians. The topics of questions commonly focused on medication-based HIV prevention strategies (22.7%), PrEP laboratory ordering/monitoring (17.4%), and side effects and contraindications (14.6%). The majority of teleconsultations (57.9%) involved sharing information that was directly available/addressed in the Centers for Disease Control and Prevention (CDC) 2017 PrEP Guidelines (i.e., low complexity).Discussion:The low frequency of consultations from nonphysician and non-nurse practitioner providers may suggest a need for increased training and collaborative opportunities for other types of providers. The high percentage of low-complexity inquiries may reveal a desire for capacity-building materials specifically designed for practicing providers (e.g., abridged versions of guidelines). This study may inform future research, best clinical practices, and aid in the development of training materials to increase providers' HIV prevention comfort and knowledge.