Scheduling, workflow initiative doubles visits for HIV PrEP
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A nurse-led multidisciplinary initiative targeted at providers and medical staff doubled the number of patients who scheduled a follow-up routine visit for HIV preexposure prophylaxis, or PrEP.
The findings were presented at the Society of General Internal Medicine annual meeting.
“This initiative was important because patients receiving PrEP are recommended to have a follow-up every 3 months in order to assess adherence and perform testing for sexually transmitted infections,” Alekses Clifton, MD, an internal medicine resident at the University of Utah School of Medicine, told Healio.
At a single academic primary care site, Clifton and colleagues observed that patients were twice as likely to attend a follow-up PrEP visit within 90 days if their appointment was scheduled during prior visits. However, they also found that follow-up appointments were scheduled during only 24% of initial PrEP visits. To improve the scheduling process, they disseminated a written scheduling protocol/flowsheet, offered peer coaching and regular didactics and encouraged the use of non-stigmatizing ICD-10 codes.
After 4 months of the initiative, 54% of patients were scheduled for follow-up routine PrEP visits compared with 24% at baseline. Clifton and colleagues also reported that 77% of patients who were scheduled using the new protocol had no gaps in PrEP medication access over a 6-month period compared with 29% of patients who were not scheduled for a 3-month follow-up visit. In addition, the percentage of PrEP visits associated with a non-stigmatizing ICD-10 code increased from 59% to 79%, according to the researchers.
“Now that physicians and clinical staff have been using the workflow for several months, we anticipate the results to continue to improve,” Clifton said. “It’s likely that there won’t be another substantial increase but maintenance or a gradual improvement in numbers is expected.”
The initiative could benefit other conditions requiring regular follow-ups or lab checks, such as patients with diabetes who are recommended to undergo A1C testing every 3 months, according to Clifton.