Pediatrician Preferences for Electronic Clinical Decision Support to Facilitate HIV Pre-Exposure Prophylaxis

Abstract

Purpose: Pediatric primary care clinicians are often uncertain about patients' HIV infection risk and pre-exposure prophylaxis (PrEP) prescribing guidelines. This study was conducted to help identify ways to design and deliver useful electronic health record (EHR)-based alerts for PrEP to help mitigate this issue.

Methods: Individual interviews and focus groups with pediatricians explored provider preferences for clinical decision support around PrEP in the EHR. Key themes were identified via the immersion-crystallization qualitative analytic technique.

Results: Clinicians described ideal decision support tools as succinct, helpful in identifying patients at risk of acquiring HIV, providing automated follow-up, and linking to evidence-based prescribing guidelines. Concerns emerged about alert fatigue.

Discussion: This study summarizes clinicians' preferences for EHR tool development to support PrEP provision among pediatricians with limited comfort and experience with prescribing PrEP. These findings can inform the development of PrEP decision support by implementing provider-centered feedback.

Keywords: Clinical decision support; EHR alerts; Human immunodeficiency virus; Pre-exposure prophylaxis; Primary care.