Expedited Partner Therapy for Sexually Transmitted Infections in Minnesota: A Mixed-Methods Review of Current Practices and Barriers to Implementation

Abstract

Review of Current Practices and Barriers to Implementation We examined 1) current provision of expedited partner therapy (EPT) for sexually transmitted infections (STI) and 2) barriers and facilitators to EPT provision in Minnesota to address rising chlamydia and gonorrhea rates across the state. We conducted a statewide online survey on STI treatment and barriers to Expedited Partner Therapy (EPT), or patient-delivered partner therapy for chlamydia or gonorrhea without medical evaluation of the partner. To develop survey questions and responses, we carried out 15 key informant interviews (KII) with health providers who submitted EPT protocols to the Minnesota Department of Health to understand current EPT implementation. KIIs were conducted among providers at outpatient specialty clinics (12), outpatient primary clinics (2), and a commercial pharmacy (1). EPT and direct provision of medication (8 for both) were mentioned as important for partner treatment. Almost all providers interviewed offer treatment directly (14), and insurance and prescriptions issues were most frequently cited administrative barriers (12). Online survey respondents (n=708) included 217 pharmacists, 230 nurse practitioners, 155 physicians, and 106 other health professionals from 63 of the 87 counties in Minnesota. While most providers had heard of EPT (72%), only 467 (66%) thought it was legal in Minnesota, and many were unsure if it was allowed in their clinical practice (34%). While only 175 providers currently offer EPT to patients, 329 providers indicated willingness to offer EPT under certain conditions. These conditions include legal protections for providers from liability (19%), changes to electronic health record (EHR) system alerts and EHR prescription options (18%), and pharmacy requirements to check for allergies (18%). Improving provider education about EPT legality may facilitate EPT provision in health systems to reduce the STI burden. Coordination between prescribing and dispensing providers is also important to overcome administrative barriers and to prevent adverse reactions among patients.