EPT in the ED
Why should the ED consider EPT?
EPT is for individuals who are unlikely to seek timely care for a presumed STI diagnosis. Patients who use the ED for STI care may have barriers to healthcare access. Their partners may be less likely navigate the steps between presumed diagnosis and ultimate treatment. EPT in the ED is a targeted measure that ensures that individuals at high-risk for being untreated get the STI cures that they need.
Why is the current state of EPT in EDs?
A national survey of ED medical directors using the Academy of Academic Administrators of Emergency Medicine (AAAEM) Benchmarking Group from 2020 found the following:
Awareness of EPT was high (73%) but fewer knew how to prescribe (38%), and only 19% had implemented EPT. Most (79%) supported EPT, and were more likely to support if they were aware of EPT (89% vs 54%) Of non-implementers, 41% thought EPT was feasible and 56% thought departmental support would be likely.
How has ED-EPT worked in pilots?
We initiated and evaluated a pilot program at our emergency department (ED) to dispense medication-in-hand (“take-home”) expedited partner therapy (EPT) kits or offer paper prescriptions for EPT. We assessed the frequency of EPT prescribing, examined the efficacy of a randomly shown best practice advisory (BPA) to encourage ED clinician EPT prescribing, queried ED clinicians about their perceptions of the EPT pilot program, and explored factors associated with EPT prescribing.
We conducted this pilot study at a large, urban, academic ED in the midwestern US between August and October 2021. After the EPT pilot program was deployed, we measured EPT prescribing and interviewed twenty ED staff members (physicians, physician assistants, and nurses) about their experience with the program and perceived barriers and facilitators to EPT prescribing. We employed a rapid assessment method for the analysis of the interviews.
Fifty-two ED patients were treated for chlamydia/gonorrhea during the study period. EPT was offered to 25% (95% CI 15%-39%) of patients. EPT was prescribed more than twice as often (85% vs. 38%; p<0.01) when the interruptive pop-up alert BPA was shown. Barriers identified in the interviews included workflow constraints and knowledge of EPT availability. The BPA was viewed positively by the majority of participants.
In this pilot EPT program, we were able to provide EPT to 25% of ED patients who appeared to be eligible to receive it. The interruptive pop-up alert BPA greatly increased EPT prescribing. Barriers identified to EPT prescribing can be the subject of future interventions to improve ED EPT provision.