TY - JOUR
T1 - Provider perspectives on clinical decision support to improve HIV prevention in pediatric primary care
T2 - a multiple methods study
AU - Pickel, Julia
AU - Fiks, Alexander G.
AU - Karavite, Dean
AU - Maleki, Pegah
AU - Beidas, Rinad S.
AU - Dowshen, Nadia
AU - Petsis, Danielle
AU - Gross, Robert
AU - Wood, Sarah M.
N1 - Funding Information:
We want to thank the network of primary care providers for their contribution to this project and clinical research facilitated through the Pediatric Research Consortium (PeRC) at The Children’s Hospital of Philadelphia.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - Background: Clinical decision support (CDS) is a promising intervention for improving uptake of HIV testing and pre-exposure prophylaxis (PrEP). However, little is known regarding provider perspectives on acceptability, appropriateness, and feasibility of CDS for HIV prevention in pediatric primary care, a key implementation setting. Methods: This was a cross-sectional multiple methods study utilizing surveys and in-depth interviews with pediatricians to assess acceptability, appropriateness, and feasibility of CDS for HIV prevention, as well as to identify contextual barriers and facilitators to CDS. Qualitative analysis utilized work domain analysis and a deductive coding approach grounded in the Consolidated Framework of Implementation Research. Quantitative and qualitative data were merged to develop an Implementation Research Logic Model to conceptualize implementation determinants, strategies, mechanisms, and outcomes of potential CDS use. Results: Participants (n = 26) were primarily white (92%), female (88%), and physicians (73%). Using CDS to improve HIV testing and PrEP delivery was perceived as highly acceptable (median score 5), IQR [4–5]), appropriate (5, IQR [4–5]), and feasible (4, IQR [3.75–4.75]) using a 5-point Likert scale. Providers identified confidentiality and time constraints as two key barriers to HIV prevention care spanning every workflow step. With respect to desired CDS features, providers sought interventions that were integrated into the primary care workflow, standardized to promote universal testing yet adaptable to the level of a patient’s HIV risk, and addressed providers’ knowledge gaps and bolstered self-efficacy in providing HIV prevention services. Conclusions: This multiple methods study indicates that clinical decision support in the pediatric primary care setting may be an acceptable, feasible, and appropriate intervention for improving the reach and equitable delivery of HIV screening and PrEP services. Design considerations for CDS in this setting should include deploying CDS interventions early in the visit workflow and prioritizing standardized but flexible designs.
AB - Background: Clinical decision support (CDS) is a promising intervention for improving uptake of HIV testing and pre-exposure prophylaxis (PrEP). However, little is known regarding provider perspectives on acceptability, appropriateness, and feasibility of CDS for HIV prevention in pediatric primary care, a key implementation setting. Methods: This was a cross-sectional multiple methods study utilizing surveys and in-depth interviews with pediatricians to assess acceptability, appropriateness, and feasibility of CDS for HIV prevention, as well as to identify contextual barriers and facilitators to CDS. Qualitative analysis utilized work domain analysis and a deductive coding approach grounded in the Consolidated Framework of Implementation Research. Quantitative and qualitative data were merged to develop an Implementation Research Logic Model to conceptualize implementation determinants, strategies, mechanisms, and outcomes of potential CDS use. Results: Participants (n = 26) were primarily white (92%), female (88%), and physicians (73%). Using CDS to improve HIV testing and PrEP delivery was perceived as highly acceptable (median score 5), IQR [4–5]), appropriate (5, IQR [4–5]), and feasible (4, IQR [3.75–4.75]) using a 5-point Likert scale. Providers identified confidentiality and time constraints as two key barriers to HIV prevention care spanning every workflow step. With respect to desired CDS features, providers sought interventions that were integrated into the primary care workflow, standardized to promote universal testing yet adaptable to the level of a patient’s HIV risk, and addressed providers’ knowledge gaps and bolstered self-efficacy in providing HIV prevention services. Conclusions: This multiple methods study indicates that clinical decision support in the pediatric primary care setting may be an acceptable, feasible, and appropriate intervention for improving the reach and equitable delivery of HIV screening and PrEP services. Design considerations for CDS in this setting should include deploying CDS interventions early in the visit workflow and prioritizing standardized but flexible designs.
KW - HIV
KW - Implementation science
KW - Implicit bias
KW - Pediatrics
KW - Pre-exposure prophylaxis
KW - Primary care
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U2 - 10.1186/s43058-023-00394-7
DO - 10.1186/s43058-023-00394-7
M3 - Article
C2 - 36810099
AN - SCOPUS:85165271415
SN - 2662-2211
VL - 4
JO - Implementation Science Communications
JF - Implementation Science Communications
IS - 1
M1 - 18
ER -
