Enhancing Patient Care: Addressing Barriers in the DoxyPEP Workflow in Ambulatory Primary Care

Purpose: Doxycycline post-exposure prophylaxis (DoxyPEP) is an emerging strategy for preventing sexually transmitted infections (STIs) in high-risk populations, such as men who have sex with men (MSM), commercial sex workers, and individuals with multiple sexual partners. A registered nurse (RN)-led initiative was launched to streamline the DoxyPEP process within the ambulatory care setting of a metropolitan teaching hospital's primary care clinic. The RN conducted a root cause analysis and identified three critical areas for improvement: physician knowledge sharing, standardization of electronic prescriptions, and enhancement of patient teaching materials. The project's aim was to address these issues and close existing gaps in care pathways.
Description: The implementation of the streamlined process followed the plan-do-study-act (PDSA) framework over one year and included monthly stakeholder meetings to track progress. In the first quarter, the clinic hosted Professor Dr. DoMarco from the University of Rochester, the project investigator behind the New York PrEP guidelines, to educate clinic providers and disseminate valuable insights.
In the second quarter, the care team collaborated with the Epic team to standardize DoxyPEP prescriptions, ensuring that all instructions were clear and precise. The third quarter focused on creating educational materials with the patient education staff, producing resources at a 10th-grade reading level. These materials included infographics and were made available in both English and Spanish to enhance patient comprehension.
Evaluation: By the fourth quarter, the care team reported a remarkable 100% patient satisfaction rate for DoxyPEP consultations, a significant increase from the 65% satisfaction rate observed prior to the intervention. The streamlined DoxyPEP process markedly improved patient safety regarding STI prevention and contributed to public health initiatives aimed at reducing STI infection rates. Additionally, the initiative projected savings of $120,000 per month in treatment and consultations at the local community level, underscoring the necessity of broadening STI prevention tools across public health initiatives.
Conclusion: The outcomes of this project underscore the effectiveness of systematic improvements in healthcare delivery, particularly for critical interventions like DoxyPEP. By ensuring that high-risk populations receive adequate care and education, the initiative not only enhances patient safety and satisfaction but also promotes broader public health objectives. Expanding access to effective STI prevention strategies is essential for mitigating infection rates and fostering healthier communities.