Quality-Improvement Initiative for Expedited Partner Therapy Provision in an Obstetrics and Gynecology Office

Women of childbearing age are disproportionately affected by sexually transmitted infections (STIs), which lead to pelvic inflammatory disease and infertility, and have other serious implications. Sexual partners of patients diagnosed with gonorrheal or chlamydial infections are at high risk of STIs. Expedited partner therapy (EPT), an evidence-based practice, allows for treatment of sexual partners of patients diagnosed with STIs without an examination to prevent reinfection and reduce transmission. The Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists support use of EPT. However, few clinicians diagnosing STIs infrequently offer this therapy. Previous studies suggest that major barriers to utilization of EPTare lack of clinician knowledge and lack of standardization of prescription. More implementation practices of EPT are needed before determining how to enable clinicians to overcome these barriers. One such barrier that has prevented a standardization of incorporating this treatment into routine practice among state and local jurisdictions is the legal status of EPT. Appropriate provision was provision using a method approved by the Connecticut Department of Public Health, limited to written prescription or dispensation of medication in a clinic. The aim of this quality-improvement (QI) initiative was to improve appropriate EPT prescription at a single clinic, in accordance with Connecticut state regulations. The study was conducted at an urban hospital-based outpatient clinic in Hartford, Connecticut, to improve prescribing of EPT to at least 70% of eligible patients. Rates of appropriate provision of EPT improved with interventions from 21.6% to 75.5%. An unexpected decrease in acceptance by patients after initiation of the interventions was noted (81.3% vs 50.5%). These data show that the goal of improving rates of appropriate provision of EPT to greater than 70% was achieved and has been maintained over time. Future studies should address the role of barriers for EPTacceptance, including infection type, the effect of Department of Public Health regulation of prescribing options, and standard workflow in patient counseling.

Automated summary

Women of childbearing age are disproportionately affected by sexually transmitted infections (STIs), but expedited partner therapy (EPT) can effectively treat the sexual partners of patients diagnosed with STIs. However, there are barriers to implementing this therapy, such as lack of clinician knowledge and lack of standardization of prescription. This quality-improvement initiative aimed to improve appropriate EPT prescription at a single clinic in Connecticut.