Tools to Ease Non-Infectious Disease Provider Comfort Prescribing PrEP

To help non-infectious disease providers feel more comfortable discussing and prescribing pre-exposure prophylaxis (PrEP) to their patients, investigators sought to evaluate how a passive education resource could make an impact.

In a poster presented at the Making a Difference in Infectious Disease (MAD-ID) 2022 annual meeting, held May 18-21, 2022, in Orlando, Florida, Margaret Pertzborn, PharmD, a PGY-2 infectious diseases pharmacy resident at Carilion Clinic in Roanoke, Virginia, shared the outcomes of the study.

Transcript has been edited for clarity and length.

Contagion®: What prompted this study, “Pre-Exposure Prophylaxis Provider Toolkit Implementation and Impact in Ambulatory Clinics”?

Pertzborn: With pre-exposure prophylaxis, or PrEP, there are a lot of issues with primary care providers prescribing PrEP. There's a purview paradox that goes on where the primary care providers feel as though PrEP prescribing is outside of their purview and prefer the infectious diseases specialists to do the prescribing. But the infectious diseases specialists feel as though PrEP is better managed and followed up by the primary care providers. So to increase the access to PrEP in our area, because Carilion Clinic does have over 200 ambulatory clinics, we wanted to make sure our primary care providers were getting the education they needed to appropriately prescribed PrEP. We came up with the idea to have a handout in a little toolkit of an educational resource for our primary care providers to appropriately prescribe PrEP to their patients.

Contagion®: What was included in the PrEP Provider toolkit that was disseminated?

Pertzborn: The provider toolkit was made up of a few different things. It started out with a PrEP-at-a-Glance handout, which was a 1-page overview of the very basics you need to appropriately prescribed PrEP. We then had our Carilion Clinic PrEP guideline, which went a little bit more in depth about the laboratory monitoring. Additionally, because affordability is a concern with PrEP as well in patients, we had an affordability guidance in which we had an overview of how to get patients PrEP who had commercial insurance, had no insurance, or had Medicare, Medicaid, or military insurance. And then, last but not least, we had a medication review of both of the primary PrEP medications emtricitabine/[tenofovir alafenamide] and emtricitabine/[tenofovir disoproxil fumarate].

Contagion®: Can you summarize the results?

Pertzborn: Our primary outcome was the increase in PrEP prescriptions, which we defined as per 100 total PrEP prescriptions, we didn't actually see a difference in this outcome, likely due to the COVID-19 pandemic. [With] PrEP being lifestyle medication, as we know, everyone's lifestyle has changed over the last few years. But we did see an increase in our primary care providers being the providers who are prescribing PrEP. So in our pre-group, we had about 19% of our prescriptions coming from primary care providers, and in our post group that was up to 30% of the prescriptions coming from primary care providers. Additionally, we saw more clinics prescribing PrEP and a 50% increase in the number of providers within Carilion Clinic prescribing PrEP to their patients.

Contagion®: What is the key takeaway for clinicians?

Pertzborn: I think the key takeaway and what we've learned from this is that we all know that providers are willing and able to prescribe PrEP. [But] they might not have the education that they need or the background, so a resource such as this is going to be very useful in getting that education out to providers. However, there's still room for other resources and educational interventions to be done, such as in-person lectures or an active education resource or also implementing pharmacists within PrEP and PrEP prescribing to help close that gap further. But, as a first step, I think a passive education resource such as this is very useful in ensuring our patients have access to PrEP.