Enhancing an Expedited Partner Therapy Program With an Electronic Alert System in the Emergency Department

Document Type

Conference Proceeding

Publication Date

4-20-2023

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: Sexually transmitted infections (STIs) are a significant public health problem and represent a large health disparity among non-Hispanic Blacks. Differential access to quality sexual health care exists, and expedited partner therapy (EPT) is a public health strategy to ensure that sexual partners of patients diagnosed with STIs are treated, breaking the cycle of infection that drives higher rates of infections in underserved communities. With 50%-90% of Chlamydia trachomatis and Neisseria gonorrhoeae infections being asymptomatic, treating patients' sexual partners is essential to lower transmission rates and improve public health. The purpose of this study was to evaluate if implementation of an automated electronic medical record (EMR) alert would increase emergency department (ED) clinician ordering of EPT. Methods: In partnership with the State of Michigan we initiated an EPT program at a large, urban ED and collected EMR data on the program. EPT kits were comprised of oral antibiotics, condoms and educational information for patients to provide their partner (s). Partners were eligible if the patient was willing to provide a kit and the patient deemed their partner unlikely to seek STI treatment. The program began in January 2022 and an EMR alert was initiated on June 15, 2022 that was triggered by any of >1600 STI related diagnostic codes. We tracked kit orders, unique clinicians ordering kits, and STI rates. Results: From January 26th, 2022 to December 14th, 2022 there were 71,075 ED visits included in the analysis. All together there were 67 EPT kits ordered and administered to 58 unique patients. From program initiation to EMR alert implementation there were 0.11 EPT kits ordered/day (16/140) compared to 0.28 EPT kits ordered/ day after the EMR alert implementation (51/182) (odds ratio 3.0, 95% CI 1.6-5.6). The rate of EMR alerts resulting in an EPT kit order was 5.56% (45/810). Seven unique clinicians ordered EPT kits in the 140 day prior to EMR alert implementation compared to 26 unique clinicians in the 182 day after alert implementation. Among patients ordered EPT kits, 31/58 (53.45%) subsequently tested positive for an STI. Conclusion: The EMR alert increased both the number EPT kits ordered and the number of clinicians ordering EPT. The prevalence of STI amongst patients ordered EPT kits was relatively high. Further studies on the role and impact of EPT from the ED on health disparities are needed.

Volume

30

First Page

237

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