Expedited Partner Therapy: Pharmacist Refusal of Legal Prescriptions

Borchardt, Lauren N; Pickett, Michelle; Tan, Kevin Tee Liang; Visotcky, Alexis; Drendel, Amy L.

doi:10.1097/olq.0000000000000751

Cited by 13 publications

(4 citation statements)

References 12 publications

(7 reference statements)

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“…Providers should visit https://www.cdc.gov/std/ept to obtain updated information for their state. Providing patients with packaged oral medication is the preferred approach because the efficacy of EPT using prescriptions has not been evaluated, obstacles to EPT can exist at the pharmacy level ( 121 , 122 ), and many persons (especially adolescents) do not fill the prescriptions provided to them by a sex partner ( 123 , 124 ). Medication or prescriptions provided for EPT should be accompanied by educational materials for the partner, including treatment instructions, warnings about taking medications (e.g., if the partner is pregnant or has an allergy to the medication), general health counseling, and a statement advising that partners seek medical evaluation as soon as possible for HIV infection and any symptoms of STIs, particularly PID.…”

Section: Clinical Prevention Guidancementioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,611

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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Section: Clinical Prevention Guidancementioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,611

2,621

View full text Add to dashboard Cite

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“…13,16 In addition, difficulties in ordering EPT through the EHR and challenges navigating pharmacy requirements that may differ with state laws surrounding EPT have been reported as barriers. 12,17 Borchardt et al 18 found that 58% of EPT prescriptions were refused by pharmacies in Wisconsin, despite the fact that EPT is legal without requiring the partner's name. Pharmacies often reported requirements (such as partner's name and date of birth) conflicting with state law.…”

Section: Discussionmentioning

confidence: 99%

Reducing Barriers for Expedited Partner Treatment in Adolescents and Young Adults: A Quality Improvement Initiative

Richards,

Bogart,

Sheeder

2024

Sexual Trans Dis

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Background Adolescents and young adults (AYA) face significant barriers to screening, testing and treatment for sexually transmitted infections (STIs). Expedited partner therapy (EPT) streamlines partner treatment for STIs but use among adolescents is low. We aimed to increase EPT offering and provision at two adolescent medicine clinics (AMC) and the emergency department (ED) in an urban children’s hospital. We addressed barriers at provider, pharmacy, and patient levels. We compared EPT offering and provision for chlamydia (CT) and trichomonas (TV) infection at baseline, and across two intervention cycles. Methods Baseline data was collected from 7/2019-3/2020 and our intervention time frame spanned from April 2020-October 2021. Laboratory codes identified patients with CT or TV infections. Cycle one allowed providers to order EPT within a patient’s chart. The second cycle targeted education and standardization for STI/EPT notification and counseling. During this cycle, notification of ED patients was centralized to the AMC nurses. Results A total of 747 CT and TV cases were identified. In the AMC, EPT offering increased from 77.3% to 87.7% (p = 0.01). EPT provision increased from 32.3% to 69.9% (p < 0.001). EPT offering for ED patients increased by 82.3%. Retesting rates remained consistent, with a significant drop in reinfection rates (p = 0.003) within patients seen in the AMC. Conclusions This QI initiative successfully increased EPT offering and provision among the cases identified. Future cycles may include longer-term follow up to confirm partner treatment and testing per guidelines.

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“…There are additional challenges for patients who receive a prescription for EPT, rather than antibiotics to give directly to their partners. Potential embarrassment [ 26 ], pharmacists’ refusal to fill prescriptions without patient identifiers [ 27 ], and out-of-pocket expenses when a partner does not have insurance or when an index patient’s insurance does not cover multiple doses of treatment [ 28 ] may preclude the prescription from being filled. Even when cost barriers are removed, less than half of EPT prescriptions are filled [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of an Electronic Medical Record Best Practice Alert on Expedited Partner Therapy for Chlamydia Infection and Reinfection

Willis

Elder

Cocoros

et al. 2021

Open Forum Infectious Diseases

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Background Atrius Health implemented a best practice alert (BPA) to encourage clinicians to provide expedited partner therapy (EPT) in October 2014. We assessed the impact of the BPA on EPT provision and chlamydial reinfection; and the impact of EPT on testing for chlamydia reinfection and reinfection rates. Methods We included patients ≥15 years with ≥1 positive chlamydia test between January 2013-March 2019. Tests-of-reinfection were defined as chlamydia tests 28-120 days after initial infection and corresponding positive results were considered evidence of reinfection. We used interrupted time series analyses to identify changes in 1) frequency of EPT; 2) tests-of-reinfection; 3) reinfections after the BPA was released. Log-binomial regression models, with GEE methods, assessed associations between EPT and tests-of-reinfection, and EPT and reinfection. Results Among 7,267 chlamydia infections, EPT was given to 1,475 (20%) patients. EPT frequency increased from 15% to 22% of infections between January 2013-September 2014 (β =0.003, p=0.03). After the BPA was released, EPT frequency declined to 19% of infections by March 2019 (β =-0.004, p=0.008). On average, 35% of chlamydia infections received a test-of-reinfection and 7% were reinfected; there were no significant changes in these percentages after BPA implementation. Patients given EPT were more likely to receive tests-of-reinfection (prevalence ratio (PR) 1.09, 95% CI: 1.01-1.16) but without change in reinfections (PR 0.88, 95% CI: 0.66-1.17). Conclusions BPAs in electronic medical record systems may not be effective at increasing EPT prescribing and decreasing chlamydial reinfection. However, patients given EPT were more likely to receive a test of chlamydia reinfection.

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Expedited Partner Therapy: Pharmacist Refusal of Legal Prescriptions

Abstract: More than half of nameless EPT prescriptions were refused in Milwaukee county pharmacies, more frequently at suburban pharmacies and for white patients. Increased pharmacist education regarding EPT is essential to help combat the sexually transmitted infection crisis.

Cited by 13 publications

References 12 publications

Sexually Transmitted Infections Treatment Guidelines, 2021

Sexually Transmitted Infections Treatment Guidelines, 2021

Reducing Barriers for Expedited Partner Treatment in Adolescents and Young Adults: A Quality Improvement Initiative

Impact of an Electronic Medical Record Best Practice Alert on Expedited Partner Therapy for Chlamydia Infection and Reinfection

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