Bring EPT to Your ED
This process can be complicated, but if planned well can create a steam-lined protocol that will make doing the right thing to do, the easy thing to do.
Implementing EPT is a big step that EDs can take towards advancing health equity. Because EPT involved treating a the partner who was not a patient in your ED, figuring out specific pathways to institute will take a multidisciplinary team with clinicians, administration, legal, nursing, pharmacy, informatics, faculty, residents all coming together to figure out what can work at your site.
Potential EPT Workflows
Every ED will find a local answer to what works best for allocating tasks to accomplish EPT. Here are some suggested samples.
Teach Your Colleagues
Help educate your colleagues and potential prescribers by asking for time during your next EM department meetings for a 10 minute presentation on EPT. Please check with your health department and hospital guidelines to modify this slideshow as appropriate to your local setting.
Engage your colleagues
Meet with key stakeholders (medical directors, nursing, pharmacy, EHR builders, informatics officers, hospital legal counsel) to determine what orders and policies work best for your group.
For patients identified as positive in follow-up, work with your medical director and follow-up office (nurse/ PA/ NP/pharmacists) to create straightforward protocols for offering EPT once lab-confirmed.
Unfortunately, EPT is not a process that will happen on its own in the ED. But by learning about EPT and becoming a departmental champion, you can take the critical first step in moving EM closer towards improving the sexual and reproductive health of our patients.
Talk with your Medical Directors
Medical Directors and key informants in emergency departments shared perspectives on facilitators and barriers to EPT. Generally, public health and protecting vulnerable populations was acknowledged as core to the EM mission, however, numerous barriers caused hesitation. These barriers included stigma, awareness issues, competing demands, medicolegal liability, and concern for patient safety. Departmental champions and clear delineation of task responsibilities through team-based care could help to overcome these challenges.
Public Health: Emergency medicine has a complicated relationship with public health
Stigma: Cultural stigma around sex causes emergency medicine providers to avoid discussion of sexual health.
Process gap: Awareness of new EPT pathways is challenging but can be overcome by streamlined processes
Ambiguity of fiduciary relationship: Non-traditional care process presents medicolegal, safety, and EMR concerns
Champions can be effective in overcoming EPT barriers through leadership, institutional longevity and bandwidth
For more details of a qualitative study regarding EPT medication kit design:
McBride K, Goldsworthy RC, Fortenberry JD. Formative design and evaluation of patient-delivered partner therapy informational materials and packaging. Sex Transm Infect. 2009;85(2):150-155. doi:10.1136/sti.2008.033746
Consider take-home EPT medications
According to the 2015 CDC STD Guidelines, medications in hand are preferrable to prescription EPT.
"Providing patients with appropriately packaged medication is the preferred approach to PDPT because data on the efficacy of PDPT using prescriptions is limited and many persons do not fill the prescriptions given to them by a sex partner. Medication or prescriptions provided for PDPT should be accompanied by treatment instructions, appropriate warnings about taking medications (if the partner is pregnant or has an allergy to the medication), general health counseling, and a statement advising that partners seek medical evaluation for any symptoms of STD, particularly PID."