Insights from pharmacists and pharmacy technicians about expedited partner therapy
Kevin T. Tan A , Michelle L. Pickett A C , Lauren N. Borchardt A , Alexis M. Visotcky B and Amy L. Drendel AA Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, 999 N. 92nd Street, Suite C550, Milwaukee, WI 53226, USA.
B Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
C Corresponding author. Email: mpickett@mcw.edu
Sexual Health 16(3) 289-295 https://doi.org/10.1071/SH18185
Submitted: 3 October 2018 Accepted: 6 March 2019 Published: 24 May 2019
Abstract
Background: Expedited partner therapy (EPT) is an effective method to treat sexually transmissible infections (STIs) and prevent re-infections. Pharmacy staff play a vital role in the success of EPT. This study aims to assess pharmacy staff knowledge of EPT and identify potential barriers to filling EPT prescriptions. Methods: The study was a cross-sectional, Internet-based survey distributed to members of the Pharmacy Society of Wisconsin. Non-retired pharmacists and pharmacy technicians were eligible. EPT knowledge was dichotomised into ‘yes’ versus ‘no/unknown’. Statistical analyses included the χ2 test and Student’s two-sided t-test; using an α of 0.05. Results: Ninety-four questionnaires were analysed: 74 pharmacists, 20 pharmacy technicians. Overall, 73 (78%) knew EPT is legal in Wisconsin, 86% of pharmacists versus 45% of pharmacy technicians, P < 0.01. The mean time from graduation/training was less for participants who knew EPT is legal versus those who did not (12.8 years vs 20.2 years, P < 0.01). Sixty-four (68%) participants worked in an outpatient setting, of which 12 (19%) knew of a formal workplace EPT policy. Thirty-two (40%) of the 81 participants who had heard of EPT thought nameless EPT prescriptions should not be legal, commonly citing patient safety concerns. Conclusions: This study demonstrated inconsistent knowledge of EPT between pharmacists and pharmacy technicians. Knowledge of workplace EPT policies and patient safety concerns were barriers to EPT. Addressing these knowledge and policy barriers will be vital to improve the utilisation of EPT.
Additional keywords: barriers, sexually transmissible infections.
References
[1] Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2017. Updated 2018. Atlanta: US Department of Health and Human Services; 2017. Available online at: https://www.cdc.gov/std/stats17/default.htm [verified 8 January 2019].[2] Centers for Disease Control and Prevention. STDs at record high, indicating urgent need for prevention. Atlanta: US Department of Health and Human Services; 2017. Available online at: https://www.cdc.gov/media/releases/2017/p0926-std-prevention.html [verified 19 November 2017].
[3] Centers for Disease Control and Prevention. Expedited partner therapy in the management of sexually transmitted diseases. Atlanta: US Department of Health and Human Services; 2006. Available online at: https://www.cdc.gov/std/treatment/eptfinalreport2006.pdf [verified 3 February 2017].
[4] Division of Public Health, Wisconsin Department of Health Services. Expedited partner therapy for Chlamydia trachomatis infection, Neisseria gonorrhoeae infection and trichomoniasis: guidance for health care professionals in Wisconsin. Madison: State of Wisconsin; 2013. Available online at: https://www.dhs.wisconsin.gov/publications/p0/p00253.pdf [verified 8 June 2016].
[5] Workowski KA, Bolan GA, Centers for Disease Control and Prevention Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64 1–137.
| 26042815PubMed |
[6] Schillinger JA, Kissinger P, Calvet H, Whittington WL, Ransom RL, Sternberg MR, Berman SM, Kent CK, Martin DH, Oh MK, Handsfield HH, Bolan G, Markowitz LE, Fortenberry JD. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis 2003; 30 49–56.
| Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial.Crossref | GoogleScholarGoogle Scholar | 12514443PubMed |
[7] Golden MR, Whittington WL, Handsfield HH, Hughes JP, Stamm WE, Hogben M, Clark A, Malinski C, Helmers JR, Thomas KK, Holmes KK. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005; 352 676–85.
| Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection.Crossref | GoogleScholarGoogle Scholar | 15716561PubMed |
[8] Gannon-Loew KE, Holland-Hall C, Bonny AE. A review of expedited partner therapy for the management of sexually transmitted infections in adolescents. J Pediatr Adolesc Gynecol 2017; 30 341–8.
| A review of expedited partner therapy for the management of sexually transmitted infections in adolescents.Crossref | GoogleScholarGoogle Scholar | 28167140PubMed |
[9] Kissinger P, Mohammed H, Richardson-Alston G, Leichliter JS, Taylor SN, Martin DH, Farley TA. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis 2005; 41 623–9.
| Patient-delivered partner treatment for male urethritis: a randomized, controlled trial.Crossref | GoogleScholarGoogle Scholar | 16080084PubMed |
[10] Mohammed H, Leichliter JS, Schmidt N, Farley TA, Kissinger P. Does patient-delivered partner treatment improve disclosure for treatable sexually transmitted diseases? AIDS Patient Care STDS 2010; 24 183–8.
| Does patient-delivered partner treatment improve disclosure for treatable sexually transmitted diseases?Crossref | GoogleScholarGoogle Scholar | 20214486PubMed |
[11] Ricks JM, Swartzendruber AL, Sales JM, Boyce LS, DiClemente RJ, Rose E. Acceptance of and experiences utilising expedited partner therapy among African-American juvenile girls. Sex Health 2015; 12 364–8.
| Acceptance of and experiences utilising expedited partner therapy among African-American juvenile girls.Crossref | GoogleScholarGoogle Scholar | 26117357PubMed |
[12] Clark JL, Segura ER, Oldenburg CE, Rios J, Montano SM, Perez-Brumer A, Villaran M, Sanchez J, Coates TJ, Lama JR. Expedited partner therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial. BMC Med 2017; 15 94
| Expedited partner therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 28468648PubMed |
[13] American Academy of Pediatrics Statement of endorsement—expedited partner therapy for adolescents diagnosed with chlamydia or gonorrhea. Pediatrics 2009; 124 1264
| Statement of endorsement—expedited partner therapy for adolescents diagnosed with chlamydia or gonorrhea.Crossref | GoogleScholarGoogle Scholar |
[14] Burstein GR, Eliscu A, Ford K, Hogben M, Chaffee T, Straub D, Shafii T, Huppert J. Expedited partner therapy for adolescents diagnosed with chlamydia or gonorrhea: a position paper of the Society for Adolescent Medicine. J Adolesc Health 2009; 45 303–9.
| Expedited partner therapy for adolescents diagnosed with chlamydia or gonorrhea: a position paper of the Society for Adolescent Medicine.Crossref | GoogleScholarGoogle Scholar | 19699429PubMed |
[15] American College of Obstetricians and Gynecologist Committee opinion no 632: expedited partner therapy in the management of gonorrhea and chlamydial infection. Obstet Gynecol 2015; 125 1526–8.
| Committee opinion no 632: expedited partner therapy in the management of gonorrhea and chlamydial infection.Crossref | GoogleScholarGoogle Scholar | 26000540PubMed |
[16] Wisconsin State Legislature. Wis. Stat. § 448.035(2). Madison: State of Wisconsin; 2009. Available online at: https://docs.legis.wisconsin.gov/statutes/statutes/448/II/035/2 [verified 9 April 2019].
[17] Kissinger PJ. The challenges of implementing and evaluating prescription expedited partner therapy. Sex Transm Dis 2017; 44 109–10.
| The challenges of implementing and evaluating prescription expedited partner therapy.Crossref | GoogleScholarGoogle Scholar | 28081047PubMed |
[18] Borchardt LN, Pickett ML, Tan KT, Visotcky AM, Drendel AL. Expedited partner therapy: pharmacist refusal of legal prescriptions. Sex Transm Dis 2018; 45 350–3.
| 29465689PubMed |
[19] Golden MR, Estcourt CS. Barriers to the implementation of expedited partner therapy. Sex Transm Infect 2011; 87 ii37–8.
| Barriers to the implementation of expedited partner therapy.Crossref | GoogleScholarGoogle Scholar | 22110153PubMed |
[20] Pickett ML, Melzer-Lange MD, Miller MK, Menon S, Vistocky AM, Drendel AL. Physician adherence to Centers for Disease Control and Prevention guidelines for sexually active adolescents in the pediatric emergency setting. Pediatr Emerg Care 2018; 34 767–73.
| Physician adherence to Centers for Disease Control and Prevention guidelines for sexually active adolescents in the pediatric emergency setting.Crossref | GoogleScholarGoogle Scholar | 27749798PubMed |
[21] Rosenfeld EA, Marx J, Terry MA, Stall R, Pallatino C, Miller E. Healthcare providers’ perspectives on expedited partner therapy for chlamydia: a qualitative study. Sex Transm Infect 2015; 91 407–11.
| Healthcare providers’ perspectives on expedited partner therapy for chlamydia: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 25792537PubMed |
[22] Reid A, Rogers ME, Arya V, Edelstein ZR, Schillinger JA. Pharmacists’ knowledge and practices surrounding expedited partner therapy for Chlamydia trachomatis, New York City, 2012 and 2014. Sex Transm Dis 2016; 43 679–84.
| Pharmacists’ knowledge and practices surrounding expedited partner therapy for Chlamydia trachomatis, New York City, 2012 and 2014.Crossref | GoogleScholarGoogle Scholar | 27893596PubMed |
[23] Qin JZ, Diniz CP, Coleman JS. Pharmacy-level barriers to implementing expedited partner therapy in Baltimore, Maryland. Am J Obstet Gynecol 2018; 218 504.e1–504.e6.
| Pharmacy-level barriers to implementing expedited partner therapy in Baltimore, Maryland.Crossref | GoogleScholarGoogle Scholar |
[24] Wisconsin State Legislature. Wis. Stat. § Phar 7.015(2). Madison: State of Wisconsin; 2008. Available online at: https://docs.legis.wisconsin.gov/code/admin_code/phar/7/015/2 [verified 9 April 2019].
[25] Centers for Disease Control and Prevention. Legal status of expedited partner therapy (EPT). Atlanta: Department of Health and Human Services; 2018. Available online at: https://www.cdc.gov/std/ept/legal/default.htm [verified 22 January 2019].
[26] Centers for Disease Control and Prevention. Expedited partner therapy legal/policy toolkit. Atlanta: Department of Health and Human Services; 2016. Available online at: https://www.cdc.gov/std/ept/legal/legaltoolkit.htm [verified 22 January 2019].
[27] Lexicomp Online, Lexi-Drugs Online. Cefixime. Hudson: Wolters Kluwer Clinical Drug Information, Inc.; 2017. Accessed 1 February 2018.
[28] Shah PM, Tröster K. Safety profile of cefixime: results of a German postmarketing surveillance study of 6361 patients. Curr Therap Res 1994; 55 57–62.
| Safety profile of cefixime: results of a German postmarketing surveillance study of 6361 patients.Crossref | GoogleScholarGoogle Scholar |
[29] Gooch WM, Philips A, Rhoades R, Rosenberg R, Schaten R, Starobin S. Comparison of the efficacy, safety and acceptability of cefixime and amoxicillin/clavulanate in acute otitis media. Pediatr Infect Dis J 1997; 16 S21–4.
| Comparison of the efficacy, safety and acceptability of cefixime and amoxicillin/clavulanate in acute otitis media.Crossref | GoogleScholarGoogle Scholar | 9041624PubMed |
[30] Lexicomp Online, Lexi-Drugs Online. Azithromycin (systemic). Hudson: Wolters Kluwer Clinical Drug Information, Inc.; 2017. Accessed 1 February 2018.
[31] Division of Public Health, Wisconsin Department of Health Services. Chlamydia treatment information sheet: important information about your health. Madison: State of Wisconsin; 2010. Available online at: https://www.dhs.wisconsin.gov/publications/p0/p00197.pdf [verified 22 January 2019].
[32] Division of Public Health, Wisconsin Department of Health Services. Gonorrhea treatment information sheet: important information about your health. Madison: State of Wisconsin; 2010. Available online at: https://www.dhs.wisconsin.gov/publications/p0/p00196.pdf [verified 22 January 2019].
[33] Division of Public Health, Wisconsin Department of Health Services. Trichomoniasis treatment information sheet: important information about your health. Madison: State of Wisconsin; 2010. Available online at: https://www.dhs.wisconsin.gov/publications/p0/p00198.pdf [verified 22 January 2019].
[34] United States Census Bureau. American Community Survey (ACS) Public Use Microdata Sample (PUMS) Documentation 1-year estimate 2016 [Data File]. Washington, DC: US Census Bureau 2016. Available online at: https://datausa.io/profile/soc/291051/ [verified 30 July 2018].