Examining Provider Attitudes and Barriers toward Prescribing PrEP within Primary Care Settings in Alabama.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Southern Medical Journal Pub Date : 2024-12-01 DOI:10.14423/SMJ.0000000000001767

Landon McNellage, Erin D Snyder, Ronnie M Gravett, Olivia T Van Gerwen

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引用次数: 0

Abstract

Objectives: Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is an effective HIV prevention tool. Expanding PrEP access and utilization is made possible by incorporating it into primary care practice. This study explored the barriers in and attitudes toward prescribing PrEP to adults among primary care providers (PCPs) in Alabama, a priority HIV jurisdiction with low PrEP uptake.

Methods: We conducted in-depth interviews grounded in the Health Belief Model with Alabama physicians and advanced practice practitioners in general internal and family medicine, exploring provider experiences in collecting sexual history information from patients and prescribing PrEP. Authors used thematic analysis of transcripts to further investigate the emerging themes.

Results: From September 2022 to April 2023, eight PCPs participated in our study. Several themes regarding barriers in and attitudes toward discussing sexual health history emerged: time constraints, knowledge and training, comfort levels, and competing priorities. We identified stigma and knowledge as themes when exploring provider attitudes toward and barriers in prescribing PrEP. When discussing the benefit of PrEP provision in primary care, we also identified themes such as longevity of the patient-provider relationship and accessibility. Participants identified multiple opportunities to increase PrEP provision in primary care beyond provider education and training, such as normalizing the language, consistency in discussing sexual health history, and using streamlined efforts of gathering sexual history information.

Conclusions: With barriers hindering PrEP prescribing by Alabama's PCPs, in addition to preexisting healthcare barriers experienced by patients in the US Deep South, immediate attention is warranted. Further exploration into developing policies for streamlining sexual history intake and inclusive medical education and training regarding PrEP is needed in Alabama.

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检查提供者的态度和障碍，对处方PrEP初级保健设置在阿拉巴马州。

目的：人类免疫缺陷病毒（HIV）暴露前预防（PrEP）是一种有效的HIV预防手段。通过将PrEP纳入初级保健实践，可以扩大PrEP的获取和利用。本研究探讨了阿拉巴马州初级保健提供者（pcp）对成人处方PrEP的障碍和态度，这是一个PrEP使用率低的艾滋病毒优先管辖区。方法：基于健康信念模型，我们对阿拉巴马州的内科和家庭医学医生和高级执业医师进行了深入访谈，探讨了提供者在收集患者性史信息和开具PrEP处方方面的经验。作者使用主题分析来进一步调查新兴主题。结果：从2022年9月到2023年4月，共有8名pcp参与了我们的研究。关于讨论性健康历史的障碍和态度的几个主题出现了：时间限制、知识和培训、舒适度和竞争优先事项。在探索提供者对处方PrEP的态度和障碍时，我们确定了耻辱感和知识作为主题。在讨论初级保健中提供PrEP的好处时，我们还确定了诸如患者-提供者关系的寿命和可及性等主题。与会者确定了在提供者教育和培训之外增加初级保健中预防措施提供的多种机会，例如使语言正常化，讨论性健康史的一致性，以及使用简化的工作来收集性病史信息。结论：由于阿拉巴马州的pcp阻碍PrEP处方的障碍，除了美国深南部患者先前存在的医疗障碍之外，立即引起注意是必要的。阿拉巴马州需要进一步探索制定精简性史摄入和关于PrEP的包容性医学教育和培训的政策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Southern Medical Journal 医学-医学：内科

CiteScore

1.40

自引率

9.10%

发文量

222

审稿时长

4-8 weeks

期刊介绍： As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients'' daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical specialties, surgery and surgery specialties; child and maternal health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.