scholarly journals 1286. Healthcare Provider Attitudes and Knowledge Around Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV-Infection in Tennessee

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S463-S463
Author(s):  
Emily Moore ◽  
Sean Kelly ◽  
Leah Alexander ◽  
Patrick Luther ◽  
Robert Cooper ◽  
...  
Keyword(s):  
Primary Care Providers ◽  
Sexual History ◽  
Categorical Variables ◽  
Care Providers ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Provider Attitudes ◽  
Heterosexual Male ◽  
Sexual Histories ◽  
Exposure Prophylaxis

Abstract Background Daily pre-exposure prophylaxis (PrEP) is very effective at preventing HIV acquisition. PrEP use in the southern United States is low despite high regional HIV prevalence. Prior surveys of primary care providers (PCPs) regarding PrEP occurred before recent guideline updates, were not constructed using a theoretical behavioral framework and validated, or did not focus on the South. Methods We conducted a cross-sectional survey of Tennessee (TN) PCPs from March-April 2019 to assess PrEP knowledge, attitudes, and prescribing practices. Survey development was guided by the COM-B framework (capability, opportunity, motivation and behavior) and validated by pilot testing and cognitive interviews. Knowledge scores were calculated as +1 point for each correct option and 0 points for each incorrect option (maximum score=8). Wilcoxon rank-sum tests were used to compare scores, and Fisher’s exact tests were used to compare categorical variables, between PrEP prescribers and nonprescribers. Results Among 69 respondents, 39% (n = 27) had prescribed PrEP. There were no differences in beliefs about PrEP or sense of obligation to prescribe PrEP between prescribers and nonprescribers. Patient inquiry about PrEP was significantly associated with prescription (P < 0.001); 100% of prescribers had ≥1 patient ask about PrEP in the past year vs. 29% of nonprescribers. Prescribers’ median PrEP knowledge scores were higher than nonprescribers’ (Figure 1). Prescribers had higher self-reported ability to take sexual histories for MSM and heterosexual male patients than nonprescribers (P = 0.007, P = 0.007), and higher self-reported comfort with taking sexual histories for MSM, heterosexual male, and heterosexual female patients (P = 0.061, P = 0.005, P = 0.026, respectively). Nonprescribers frequently cited a need for training in PrEP contraindications and eligibility, cost of PrEP, and administrative burden as barriers to provision. Conclusion Less than half of TN PCPs we surveyed prescribed PrEP despite similar senses of obligation and PrEP-related beliefs between prescribers and nonprescribers. Future interventions to improve PrEP provision among PCPs in TN should target PrEP knowledge, ability and comfort with sexual history taking, and patient awareness of and ability to inquire about PrEP. Disclosures All authors: No reported disclosures.

scholarly journals Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis

2020 ◽  
Vol 11 ◽  
pp. 215013272098441
Author(s):  
Emily Moore ◽  
Sean G. Kelly ◽  
Leah Alexander ◽  
Patrick Luther ◽  
Robert Cooper ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Medicine ◽  
Primary Care Providers ◽  
Sexual History ◽  
Categorical Variables ◽  
Future Research ◽  
Care Providers ◽  
Prescribing Practices ◽  
Provider Attitudes ◽  
Exposure Prophylaxis

Introduction/Objectives: Pre-exposure prophylaxis (PrEP) use in the southern United States is low despite its effectiveness in preventing HIV acquisition and high regional HIV prevalence. Our objectives were to assess PrEP knowledge, attitudes, and prescribing practices among Tennessee primary care providers. Methods: We developed an anonymous cross-sectional electronic survey from March to November 2019. Survey development was guided by the Capability, Opportunity, Motivation, and Behavior framework and refined through piloting and interviews. Participants included members of professional society and health center listservs licensed to practice in Tennessee. Respondents were excluded if they did not complete the question regarding PrEP prescription in the previous year or were not in a position to prescribe PrEP (e.g., hospital medicine). Metrics included PrEP prescription in the preceding year, PrEP knowledge scores (range 0-8), provider attitudes about PrEP, and provider and practice characteristics. Knowledge scores and categorical variables were compared across PrEP prescriber status with Wilcoxon rank-sum and Fisher’s exact tests, respectively. Results: Of 147 survey responses, 99 were included and 43 (43%) reported PrEP prescription in the preceding year. Compared with non-prescribers: prescribers had higher median PrEP knowledge scores (7.3 vs 5.6, P < .01), a higher proportion had self-reported patient PrEP inquiries (95% vs 21%, P < .01), and a higher proportion had self-reported good or excellent ability to take a sexual history (83% vs 58%, P = .01) and comfort taking a sexual history (92% vs 63%, P < .01) from men who have sex with men, a subgroup with high HIV risk. Most respondents felt obligated to provide PrEP (65%), and felt all primary care providers should provide PrEP (63%). Conclusion: PrEP provision is significantly associated with PrEP knowledge, patient PrEP inquiries, and provider sexual history taking ability and comfort. Future research should evaluate temporal relationships between these associations and PrEP prescription as potential routes to increase PrEP provision.

scholarly journals Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

2021 ◽  
Vol 33 (4) ◽  
pp. 325-344
Author(s):  
Erik D. Storholm ◽  
Allison J. Ober ◽  
Matthew L. Mizel ◽  
Luke Matthews ◽  
Matthew Sargent ◽  
...  
Keyword(s):  
Primary Care ◽  
Claims Data ◽  
Primary Care Providers ◽  
Attitudes And Beliefs ◽  
Care Providers ◽  
Provider Education ◽  
Prescribing Practices ◽  
Sexually Transmitted ◽  
Primary Care Settings ◽  
Exposure Prophylaxis

Increasing access to pre-exposure prophylaxis (PrEP) in primary care settings for patients who may be at risk for HIV could help to increase PrEP uptake, which has remained low among certain key risk populations. The current study conducted interviews with primary care providers identified from national claims data as having either high or low likelihood of serving PrEP-eligible patients based on their prescribing practices for other sexually transmitted infections. The study yielded important information about primary care providers’ knowledge, attitudes, and beliefs about PrEP, as well as the barriers and facilitators to prescribing PrEP. Key recommendations for a provider-focused intervention to increase PrEP prescribing among primary care providers, including increasing patient education to increase demand from providers, enhancing provider education, leveraging technology, and instituting standardized sexual health checks, are provided with the goal of informing network-based interventions.

A survey of Cambodian health-care providers' HIV knowledge, attitudes and intentions to take a sexual history

2009 ◽  
Vol 20 (5) ◽  
pp. 346-350 ◽  
Author(s):  
G Webber ◽  
N Edwards ◽  
I D Graham ◽  
C Amaratunga ◽  
I Gaboury ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Theory Of Planned Behaviour ◽  
Sexual History ◽  
People Living With Hiv ◽  
Care Providers ◽  
Hiv Knowledge ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Planned Behaviour

Cambodia has one of the highest prevalence rates of HIV in Asia and is scaling up HIV testing. We conducted a cross-sectional survey with 358 health care providers in Phnom Penh, Cambodia to assess readiness for voluntary testing and counselling for HIV. We measured HIV knowledge and attitudes, and predictors of intentions to take a sexual history using the Theory of Planned Behaviour. Over 90% of health care providers correctly answered knowledge questions about HIV transmission, but their attitudes were often not positive towards people living with HIV. The Theory of Planned Behaviour constructs explained 56% of the variance in intention to take a sexual history: the control providers perceive they have over taking a sexual history was the strongest contributor (51%), while social pressure explained a further 3%. Attitudes about taking a sexual history did not contribute to intention. Interventions with Cambodian health care providers should focus on improving skills in sexual history-taking.

Clinical Implementation of a Parent Questionnaire to Identify Seizures in High-Risk Children

2020 ◽  
Vol 35 (7) ◽  
pp. 485-491
Author(s):  
Celia Greenlaw ◽  
Sarah Nuss ◽  
Cristina Camayd-Muñoz ◽  
Rinat Jonas ◽  
Julie Vanier Rollins ◽  
...  
Keyword(s):  
High Risk ◽  
Low Cost ◽  
Numerical Data ◽  
Primary Care Providers ◽  
Autism Spectrum ◽  
Categorical Variables ◽  
Care Providers ◽  
Clinical Implementation ◽  
Parent Questionnaire ◽  
High Risk Children

Background: This study evaluated the effectiveness of a parent-completed questionnaire for detecting seizures in high-risk children. Methods: A 2-part seizure screen for children up to 12 years of age with suspected autism spectrum disorder, developmental delay, or seizure, was implemented in 12 Massachusetts clinics serving populations with high health disparities. Primary care providers and developmental behavioral pediatricians administered part 1, a brief highly sensitive screen. If the result was positive, a research assistant administered part 2, a more detailed screen with higher specificity. Positive part 2 results prompted a specialized assessment by a pediatric neurologist. Screening data were evaluated for detection of seizures or other diagnoses, reason for conducting the screen, and appointment outcomes. Data analysis included chi-squared tests, percentages for categorical variables, and means for numerical data. Results: Of 207 administered seizure questionnaires, 78% of children screened positive on part 1. Of those, 94% of families completed part 2 by telephone, and 64 individuals screened positive. The screen helped to detect 15 new seizure diagnoses and 35 other neurologic diagnoses. Average time to first scheduled appointment was 23.8 days. The no-show rate was 7%. Conclusions: The seizure questionnaire effectively identified seizures and other disorders in a diverse population of high-risk children. Broader use of this low-cost screening tool could improve access to care for children with suspected seizures, increase seizure recognition, and help allocate resources more effectively.

scholarly journals 1475. Understanding Prescribing Practices for Uncomplicated Urinary Tract Infections (UTIs) in the Primary Care Setting: A Pilot Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S538-S538
Author(s):  
Mark Pinkerton ◽  
Jahnavi Bongu ◽  
Aimee James ◽  
Michael Durkin
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
Prescribing Practices ◽  
Support Tools ◽  
Tract Infections ◽  
Clinical Decision Support Tools

Abstract Background Uncomplicated urinary tract infections (UTIs) should be treated empirically with a short course of narrow-spectrum antibiotics. However, many clinicians order unnecessary tests and treat with long courses of antibiotics. The objective of this study was to understand how internists clinically approach UTIs. Methods We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018 to 2019 to explore why clinical practices deviate from evidence-based guidelines. Interviews were transcribed, de-identified, and coded by two independent researchers using NVivo qualitative software. A Likert scale was used to evaluate preferences for possible interventions. Results Several common themes emerged. Both providers and residents ordered urine tests to “confirm” presence of urinary tract infections. Antibiotic prescriptions were often based on historical practice and anecdotal experience. Providers were more comfortable treating over the phone than residents and tended to prescribe longer courses of antibiotics. Both providers and residents voiced frustrations with guidelines being difficult to easily incorporate due to length and extraneous information. Preferences for receiving and incorporating guidelines into practice varied. Both groups felt benchmarking would improve prescribing practices, but had reservations about implementation. Pragmatic clinical decision support tools were favored by providers, with residents preferring order sets and attendings preferring nurse triage algorithms. Conclusion Misconceptions regarding urinary tract infection management were common among residents and community primary care providers. Multifaceted interventions that include provider education, synthesis of guidelines, and pragmatic clinical decision support tools are needed to improve antibiotic prescribing and diagnostic testing; optimal interventions to improve UTI management may vary based on provider training level. Disclosures All authors: No reported disclosures.

scholarly journals Medical Students Have Limited Awareness, Knowledge, Beliefs, and Experiences of Pre-exposure Prophylaxis (PrEP) for HIV Prevention

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S14-S15 ◽  
Author(s):  
Brandon Imp ◽  
Elaine Allen ◽  
Jonathan Volk ◽  
Tanaya Bhowmick ◽  
Keyword(s):  
Medical Students ◽  
Hiv Prevention ◽  
Medical School ◽  
Healthcare Professionals ◽  
Medical Student Education ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Prescribing Practices ◽  
First Year Students ◽  
Exposure Prophylaxis

Abstract Background While studies of healthcare professionals have shown increasing awareness, knowledge, positive beliefs, and prescribing practices of emtricitabine/tenofovir pre-exposure prophylaxis (PrEP) for HIV prevention, PrEP is still underutilized in clinical practice. PrEP knowledge is associated with increased prescription so early education of healthcare professionals is recommended, but the extent of PrEP education in medical school is unknown. In this analysis, we describe medical students’ awareness, knowledge, beliefs, and experiences regarding PrEP. Methods Medical students at 18 US allopathic medical schools completed a survey on knowledge, beliefs, and experiences of PrEP in May–June 2016. Knowledge was assessed with a 10-question quiz on PrEP facts. No incentives to complete the survey were offered. Data were summarized by frequency (%) for categorical variables and with means (SD) for continuous variables. Chi-squared tests were used to examine differences between knowledge of PREP and other categorical variables. Results The study population (N = 1588) included women (53%), non-Caucasians (27%), and non-heterosexuals (15%). Median age was 25 (range 21–53). Forty-eight home states, including D.C., and 21 home countries were represented. 18% of fourth-year students were never taught about PrEP in medical school, compared with 40% of first-year students (P &lt; 0.001). Overall, 28% of students were unaware of PrEP. Those unaware believed patients without HIV will not adhere to PrEP (P &lt; 0.001). Awareness was associated with knowing someone with HIV besides a patient and experience caring for HIV-infected, intravenous drug-using, and LGBTQ people (P &lt; 0.001). Higher knowledge scores were associated with confidence in determining a patient’s candidacy for PrEP and, for third- and fourth-year students, having recommended PrEP in the clinical setting (P &lt; 0.001). Overally, 57% believed that behavioral intervention should be tried before prescribing PrEP, 45% believed that patients would not adhere to PrEP, and 22% worried that PrEP is not effective. Conclusion We show in an 18-site study that medical students have limited awareness, knowledge, positive beliefs, and experiences of PrEP. Given these findings and the underutilization of PrEP by current practitioners, we recommend increasing the inclusion of PrEP in medical student education. Disclosures All authors: No reported disclosures.

scholarly journals Contextual Factors Associated with Burnout among Chinese Primary Care Providers: A Multilevel Analysis

2019 ◽  
Vol 16 (19) ◽  
pp. 3555 ◽  
Author(s):  
Huiwen Li ◽  
Beibei Yuan ◽  
Qingyue Meng ◽  
Ichiro Kawachi
Keyword(s):  
Primary Care ◽  
Work Environment ◽  
Multilevel Analysis ◽  
Contextual Factors ◽  
Maslach Burnout Inventory ◽  
Primary Care Providers ◽  
Personal Accomplishment ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Work Support

Burnout is a common and growing phenomenon in the health care setting. The objective of the present study is to examine contextual factors in the workplace associated with burnout among primary care providers (PCPs) in Shandong Province, China. A cross-sectional survey was conducted among 951 PCPs nested within 48 primary health institutions (PHIs). Burnout was measured using the Maslach Burnout Inventory–Human Services Survey (MBI–HSS). We used two-level random intercept linear regression models to examine individual- versus workplace-level risk factors for burnout. The result revealed that 33.12%, 8.83% and 41.43% PCPs were experiencing a high degree of emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PA). In multilevel analysis, the most significant and common individual-level predictors of burnout were lack of perceived work support and autonomy. At the institutional level, workload was positively related to EE (odds ratio (OR): 6.59; 95% confidence interval (CI): 3.46–9.72), while work support was related to higher PA (OR: 3.49; 95% CI: 0.81–6.17). Greater attention should be paid to the influence of the work environment factors (workload and work support) to prevent burnout. Strategies such as increasing human resources allocated to PHIs and establishing a supportive work environment are encouraged to prevent and reduce burnout among PCPs in China.

Addressing the opioid crisis: An assessment of clinicians’ training experience, practices, and attitudes within a large healthcare organization

2019 ◽  
Vol 15 (3) ◽  
pp. 193-204 ◽  
Author(s):  
Harshal Kirane, MD ◽  
Elina Drits, DO ◽  
Seungjun Ahn, MS ◽  
Sandeep Kapoor, MD ◽  
Jonathan Morgenstern, PhD ◽  
...  
Keyword(s):  
Pain Management ◽  
Healthcare System ◽  
Guideline Implementation ◽  
Primary Care Providers ◽  
Healthcare Organization ◽  
Categorical Variables ◽  
Care Providers ◽  
Additional Support ◽  
Addiction Care ◽  
The Impact

Objective: To assess provider practices and attitudes toward addiction care and pain management within a large healthcare system, as well as to determine the impact of prior training and perceived effectiveness of organizational implementation strategies. Design: A cross-sectional study.Setting: Large healthcare organization comprising 21 hospitals.Participants: Three hundred and thirteen healthcare providers within a large healthcare organization.Main outcome measures: Training, practices, and attitudes toward opioid-related care.Methods: One thousand providers including physicians (MD/DO) and physician extenders (NP/PA) were contacted via email request. The Mann-Whitney test or Fisher’s exact test, as appropriate, was used for comparisons of continuous and categorical variables, respectively.Results: Providers lacked prior pain management (36 percent), addiction (38 percent), or buprenorphine training (92 percent). Few providers were confident in treating opioid use disorders (OUD) (19 percent) and opioid tapering (24 percent) but interested in safe prescribing practices (81 percent). While most providers preferred to refer patients for OUD (89 percent), only a small portion felt appropriate services were readily available (22 percent). Trained providers appear significantly more engaged in checking Prescription Drug Monitoring Program database [median = 1 (Q1 = 1, Q3 = 2) vs 2(1, 3); p 0.001], comfortable obtaining urine drug screens [2(2, 3) vs 3(2, 4); p 0.002], and willing to treat OUD with additional support [3(2, 4) vs 4(3, 4); p 0.022] compared to non-trained providers. Primary care providers were more likely to view OUDs in their scope of practice [4(2, 5) vs 4(3, 5); p 0.016] and willing to treat OUD with additional support [3(2, 3) vs 3(2, 4); p 0.0007] compared to specialists. Buprenorphine providers appear to have more confidence in skills for OUD [2(1, 3) vs 4(3, 4); p 0.0001] and tapering [2(1, 2) vs 4(3, 5); p 0.0001], and diminished preference to refer [2(1, 5) vs 1(1, 2); p 0.0009] compared to non-buprenorphine providers.Conclusions: Providers within a large healthcare system lack training and confidence in management of opioid-related care. Buprenorphine training positively modified key attitudes toward addiction care, yet engagement in medication-assisted treatment remains limited. Providers are concerned about opioid risks, and view guideline implementation and direct input from addiction specialists as effective organizational strategies. Further research is needed to clarify the efficacy of such approaches.

Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature

2017 ◽  
Vol 8 (4) ◽  
pp. 507-519 ◽  
Author(s):  
K. Draper ◽  
C. Ley ◽  
J. Parsonnet
Keyword(s):  
Health Care Providers ◽  
Medical Center ◽  
Prescribing Patterns ◽  
Care Providers ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Request ◽  
Definitive Evidence ◽  
Bowel Health

Probiotic use by patients and physicians has dramatically increased over the last decade, although definitive evidence is often lacking for their use. We examined probiotic-prescribing practices among health care providers (HCP) at a tertiary medical centre and compared these practices to clinical guidelines. HCP at the Stanford Medical Center received a survey on probiotic prescribing practices including choice of probiotic and primary indications. A broad overview of the literature was performed. Among 2,331 HCP surveyed, 632 responded. Of the 582 of these who routinely prescribed medications, 61% had recommended probiotic foods or supplements to their patients. Women and gastroenterologists were more likely to prescribe probiotics (odds ratio (OR): 1.5, 95% confidence interval (CI): 1.0-2.1; OR: 3.9, 95% CI: 1.5-10.1, respectively). Among probiotic prescribers, 50% prescribed inconsistently or upon patient request, and 40% left probiotic choice to the patient. Common indications for probiotics, particularly Lactobacillus GG, were prevention and treatment of antibiotic-associated diarrhoea (79 and 66%, respectively). Probiotics were often prescribed for ‘general bowel health’ or at patient request (27 and 39% of responders, respectively). Most respondents (63%) thought an electronic medical record (EMR) pop-up would change probiotic prescribing patterns. However, a review of published guidelines and large trials found inconsistencies in probiotic indications, dosages and strain selection. Probiotic prescribing is common but lacks consistency, with choice of probiotic frequently left to the patient, even for indications with some strain-specific evidence. Implementation of EMR pop-ups/pocket guides may increase consistency in probiotic prescribing, although the lack of clear and consistent guidelines must first be addressed with large, well-designed clinical trials.

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