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Abstract
Background Expedited partner therapy (EPT) is the practice of treating sex partners of persons with sexually transmitted diseases (STD) without an intervening medical evaluation. In 2006, the CDC issued guidelines for providing EPT to heterosexual patients diagnosed with gonorrhoea/chlamydial infection, allowing them to deliver treatment to their partner(s). In November 2006, the Denver Metro Health (STD) Clinic (DMHC) began offering EPT. We describe EPT implementation challenges and process improvements.
Methods Three phases of implementation are described: 1) the pilot phase, 2) implementation of a quality assurance protocol and 3) initiation of a prompt in the electronic medical record (EMR). Data were extracted from the EMR to calculate acceptance rates of EPT among the 2056 eligible patients over this time period. Rates were examined by month and for each phase.
Results Before initiation of the pilot phase, a protocol to dispense EPT was developed and staff trained. During the pilot phase (September 2007–April 2008), patient acceptance rates averaged 17% (range: 8%–22%). As rates were not improving, EMR data were examined to determine potential areas for intervention. At DHMC, clinical services are provided by health care partners (HCP) and licensed nurse practitioners (LNP). Analyses revealed significant differences in patient acceptance of EPT by provider type: HCP providers were less likely to have patients accept EPT than LNP providers (prevalence ratio=1.7, 95% CI: 1.5% to 1.9%), likely due to the nature of the visit and the volume of patients seen by HCP providers. Targeted re-training was initiated and quality assurance reports were generated monthly. Although the acceptance rate increased significantly to 22% (p=0.04), there was no indication that rates were increasing with time. In January 2009, the EMR was amended, requiring all providers to document EPT referral, acceptance or refusal (and reason for refusal), before closing the patient EMR. Rates improved significantly to an overall rate of 49% (p<0.01) through October 2010 (Abstract O5-S3.02 figure 1). Reasons for refusal among those who did not accept EPT included that partner would be notified (42.5%), partner was being treated (30.1%) or the patient was not able to contact the partner (21.9%).
Acceptance rates of EPT Denver Metro Health (STD) clinic.
Conclusions In a busy inner-city STD clinic, an automated EMR prompt that forces documentation of EPT provided the greatest success. An EPT acceptance rate of 50% may be the optimum rate in a real-world setting.