Why Use EPT?
The good news is the emergency department can play an important role in curbing the STI public health crisis by using a tool readily at our disposal: EPT.9 EPT has proven effective at breaking the cycle of STI reinfection. In a meta-analysis, EPT reduced reinfection rates by 29 percent and increased the number of partners treated per patient compared to telling the patient to have their partner treated (ie, simple patient referral).10
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ACEP Now: Vol 40 – No 05 – May 2021In addition to being efficacious, patients want EPT. In STD clinics, 69 percent of patients accepted EPT when offered.11 EPT is legally protected or permissible in 46 states and potentially allowed in four states.12 EPT has a history of broad-based support by the CDC, American Osteopathic Association, American Academy of Family Physicians, Society for Adolescent Health and Medicine, American College of Obstetricians and Gynecologists, and American Bar Association.13 In the 2020 ACEP Council meeting, ACEP joined these organizations in official support of EPT.14
The State of EPT in the ED
Despite the potential for EPT to help stop the spread of STIs, the practice is not yet widely used in emergency departments. Studies have identified a need to increase awareness and education among outpatient clinicians. This knowledge gap is magnified in the emergency department, where the practice has received little attention both at the training and practice levels. In a national survey of medical directors in academic emergency departments, only 19 percent reported their department had implemented EPT. Moreover, departmental uptake of its use was uneven; some physicians did not realize EPT was even legal within the reported implementer sites. Despite low awareness, there is enthusiasm for EPT: About half (56 percent) of those surveyed thought their department would support EPT, and most (79 percent) personally supported EPT. These findings demonstrate there is room for growth in the national implementation of ED-based EPT.
What Can You Do?
What are some things you can do as an individual to implement EPT in your department? Begin by checking the legal status of EPT in your state. The CDC’s website provides recent guidelines by state (www.cdc.gov/std/ept/legal), and state health departments often have guidance for clinicians and patient information sheets. If the legal status of EPT is not specified by your state’s laws, work with your state ACEP chapter to lobby for this public health intervention at your next state advocacy day. If EPT is not explicitly legally protected in your state like it is in some states, advocate that your legislature promote clarity around ambiguous laws to protect prescribers from legal liability. If your state supports it, determine the specific prescribing guidelines and refer your patients locally for follow-up testing and partner treatment.
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4 Responses to “Expedited Partner Therapy Can Stop Sexually Transmitted Infections”
June 20, 2021
Gary RobertsTreatment of partners in the setting of STIs is medically appropriate. This article did not address the pitfalls of prescribing medication for an unknown and unseen patient whose medical history cannot be confirmed. Anaphylaxis to cephalosporins is well known and there are numerous medications with potential adverse interactions with azithromycin.
As a physician, I am unwilling to subject an unknown patient to potential harm and am equally unwilling to incur the legal liability attached to an adverse outcome in this situation no matter how noble the cause. (health care equity)
The (potential) patient has the responsibility in this case. ED physicians are neither qualified nor justified to act “in loco parentis” for the community.
June 20, 2021
TWhat if partner has an allergy or adverse drug reaction. You never did a formal evaluation. Is their sovereign immunity?
June 21, 2021
Matt JaegerHow do you propose we prescribe medications to a patient we don’t have a chart for, don’t have a relationship with, haven’t performed a history on, and don’t know what their allergies are? This seem like a risk I’m not willing to take. I don’t think I’m willing to start handing out prescription to unknown individuals.
At some point, patients must take at least partial responsibility for their care and initiate a relationship with a medical provider, be it in an ER, public health clinic, walk-in clinic or a PCP.
June 21, 2021
Gary Roberts, MD, JDWhile “social justice and health equity” are noble motives and lofty goals, the reality of EPT is far more gritty.
Even granting the supposition that there may be some legal protection for the prescribing physician, what protection is there for the unexamined and unseen patient?
Cephalosporins are well-known to have a not insignificant allergic/anaphylactic profile. The myriad potential drug interactions and adverse reactions with doxycyline are well documented.
Nonetheless, the EPT approach is to expose patients to these risks without their consent and lacking any first-hand knowledge of their medical condition.
It is neither the province nor the responsibility of Emergency Medicine to act in loco parentis in these situations. The patient must bear some responsibility.
“Social justice and health equity” in this context is already being well-served. There are numerous free clinics for the treatment of STI.
https://www.yourstdhelp.com/free_clinic_locator.html
Noble motives and the possibility of legal protection are flimsy and totally inadequate excuses to expose unknown patients to significant risks.