Reticence to prescribe: utilization of expedited partner therapy among obstetrics providers in Arizona

Taylor, Melanie; Collier, Melissa G.; Winscott, Michelle; Mickey, Tom; England, Bob

doi:10.1258/ijsa.2011.010492

Cited by 15 publications

(14 citation statements)

References 11 publications

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“…The provision of EPT in women's health-care settings is an accepted option for partner treatment. 12,16,18 These findings positively reflect the patient follow-up practices of the primary and women's clinics at this facility and highlight opportunities to expand the delivery of EPT for patients diagnosed in urgent and emergent care settings.…”

Section: Discussionmentioning

confidence: 60%

Use of expedited partner therapy among chlamydia cases diagnosed at an urban Indian health centre, Arizona

et al. 2013

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Chlamydia cases diagnosed in the women's clinic were more likely to receive expedited partner therapy (EPT) and to be re-tested as compared with urgent and emergent care settings. Fewer re-infections occurred among patients who received EPT. Disproportionate rates of chlamydia occur among American Indian (AI) populations. To describe use of EPT among chlamydia cases diagnosed at an urban Indian Health Service (IHS) facility in Arizona, health records were used to extract confirmed cases of chlamydia diagnosed between January 2009 and August 2011. Medical records of 492 patients diagnosed with chlamydia were reviewed. Among the 472 cases who received treatment, 246 (52%) received EPT. Receipt of EPT was significantly associated with being female (odds ratio (OR) 2.1, 1.03-4.4, P < 0.001) and receipt of care in the women's clinic (OR 9.9, 95% CI 6.0-16.2) or in a primary care clinic (OR 2.4, 95% CI 1.1-5.1). Compared with those receiving care in the women's clinic, the odds of receipt of EPT were significantly less in those attending the urgent/express care clinic (OR 0.1, 95% CI 0.06-0.2), and the emergency department (OR 0.1, 95% CI 0.05-0.2). Among treated patients who underwent re-testing (N = 323, 68% total treated) re-infection was less common among those that received EPT (13% versus 27%; OR 0.5, 95% CI 0.3-0.9). In this IHS facility, EPT was protective in preventing chlamydia re-infection. Opportunities to expand the use of EPT were identified in urgent and emergent care settings.

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Section: Discussionmentioning

confidence: 60%

Use of expedited partner therapy among chlamydia cases diagnosed at an urban Indian health centre, Arizona

et al. 2013

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“…[15] Lastly, provider knowledge of EPT is associated with higher rates of practice, yet practice is inhibited by concern for legal liability. [16] Concern for liability exists because EPT involves prescribing and dispensing medications to individuals who have not been physically examined by a healthcare provider. Potential legal actions include medical malpractice lawsuits from individuals or censure from state professional licensure boards.…”

mentioning

confidence: 99%

The Legal Aspects of Expedited Partner Therapy Practice

Cramer

Leichliter²,

Stenger³

et al. 2013

Sexually Transmitted Diseases

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Background Expedited partner therapy (EPT) is a potential partner treatment strategy. Significant efforts have been devoted to policies intended to facilitate its practice. However, few studies have attempted to evaluate these policies. Methods We used data on interviewed gonorrhea cases from 12 sites in the STD Surveillance Network (SSuN) in 2010 (n=3,404). Patients reported whether they had received EPT. We coded state laws relevant to EPT for gonorrhea using Westlaw legal research database, and the general legal status of EPT in SSuN sites from CDC’s website in 2010. We also coded policy statements by medical and other boards. We used chi-squares to compare receipt of EPT by legal/policy variables, patient characteristics and provider type. Variables significant at p<.10 in bivariate analyses were included in a logistic regression model. Results Overall, 9.5% of 2,564 interviewed gonorrhea patients reported receiving EPT for their partners. Receipt of EPT was significantly higher where laws and policies authorizing EPT existed. Where EPT laws for GC existed and EPT was permissible, 13.3% of patients reported receiving EPT as compared to 5.4% where there were no EPT laws and EPT was permissible, and 1.0% where there were no EPT laws and EPT was potentially allowable (p<.01). EPT was higher where professional boards had policy statements supporting EPT (p<.01). Receipt of EPT did not differ by most patient characteristics or provider type. Policy-related findings were similar in adjusted analyses. Conclusions EPT laws and policies were associated with higher reports of receipt of EPT among interviewed gonorrhea cases.

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“…Some patients are averse, however, reinforcing the need for providers to discuss options with patients. One survey of obstetricians and gynecologists in Arizona found that almost one-third of respondents were reluctant to prescribe EPT because of allergy-related concerns, whereas another 11% did not prescribe EPT due to liability concerns [24]. Reasons for ambivalence vary, but often include worries about allergic reactions, liability, and incomplete care when partners do not seek evaluation.…”

Section: Uptakementioning

confidence: 99%

“…Of 466 patients treated for chlamydia in 2004-2005, 323 (69%) were provided with EPT after a discussion with their provider. The Arizona survey cited above also found that providers who were informed of guidelines permitting EPT were more likely to prescribe EPT, 69 vs. 44% [24]. Baltimore STD clinics [17] have reported substantial proportions of individuals receiving EPT (68%), as has an STD clinic in San Francisco (43%, with almost identical rates of uptake among heterosexual patients and MSM) [18].…”

Section: Uptake Evaluationmentioning

confidence: 99%

Expedited partner therapy for sexually transmitted infections

Hogben

Kidd²,

Burstein³

2012

Current Opinion in Obstetrics &Amp; Gynecology

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Clinicians should continue to be aware of the importance of partner managements for STD-infected patients, with EPT being an evidence-based intervention in that respect. The variety in EPT models provides alternatives that may suit some practices and venues. For clinicians seeing gonorrhea patients, effective counseling models - enhanced patient referral - should be closely examined in case oral treatment for gonorrhea becomes infeasible.

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Reticence to prescribe: utilization of expedited partner therapy among obstetrics providers in Arizona

Cited by 15 publications

References 11 publications

Use of expedited partner therapy among chlamydia cases diagnosed at an urban Indian health centre, Arizona

Use of expedited partner therapy among chlamydia cases diagnosed at an urban Indian health centre, Arizona

The Legal Aspects of Expedited Partner Therapy Practice

Expedited partner therapy for sexually transmitted infections

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