Expedited Partner Therapy For Chlamydia Treatment Power Point  Flagstaff July 2009  June 30 Version (6)
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Expedited Partner Therapy For Chlamydia Treatment Power Point Flagstaff July 2009 June 30 Version (6)

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A comprehensive update of Patient delivered Partner Therapy.

A comprehensive update of Patient delivered Partner Therapy.

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  • Talking Points: The intimate nature of sexuality poses special challenges to providers in discussing it with their patients. The skills required are not routinely included in the training of physicians or other primary care providers. Some clinicians will be more comfortable than others in offering counseling to patients and their partners, but most can develop sufficient skill to: Be a sympathetic listener, Reassure the patient with sexual concerns that strategies exist for addressing those concerns; Make an appropriate referral if needed. To find an American Association of Sexuality Educators, Counselors, and Therapists (AASECT) certified professional, go to www.aasect.org. - - - Original content for this slide submitted by the Clinical Advisory Committee for the Mature Sexuality Education Initiative in March 2004. Original funding received from GlaxoSmithKline Consumer Health, Pfizer Women’s Health, and Procter & Gamble Pharmaceuticals through unrestricted educational grants. Last reviewed/updated by Susan Kellogg-Spadt, PhD, CRNP, Sheryl A. Kingsberg, PhD, Kirtly Parker Jones, MD, and Beverly Whipple, PhD, RN, FAAN, in February 2007.
  • Talking Points: It is essential to evaluate all patients for risks of sexually transmitted infections (STIs), including AIDS. Never assume that because patients are older that they are not sexually active or not at risk. Older adults embarking on new relationships following separation, divorce, or death of a long-term partner may be at particular risk. Never assume that older patients can negotiate condom use better than any other patients. How does a woman negotiate the issue of condom use? This issue is just as important in older couples as in younger. The presence of STI’s such as herpes or HPV has long-term implications for patient’s sexual behavior; they must face the need to tell future sexual partners. - - - Original content for this slide submitted by the Clinical Advisory Committee for the Mature Sexuality Education Initiative in March 2004. Original funding received from GlaxoSmithKline Consumer Health, Pfizer Women’s Health, and Procter & Gamble Pharmaceuticals through unrestricted educational grants. Last reviewed/updated by Susan Kellogg-Spadt, PhD, CRNP, Sheryl A. Kingsberg, PhD, Kirtly Parker Jones, MD, and Beverly Whipple, PhD, RN, FAAN, in February 2007.
  • Talking Points: It is essential to determine if a patient has ever had a STI. (We know that having ever had a STI increases the risk of having another.) When asking this question, specify the various kinds of sexually transmitted infections, e.g.. gonorrhea, chlamydia, HIV, syphilis, hepatitis, bladder or urethral infection, rectal infection, herpes, warts; and for concrete behaviors if the patient is not informed enough to answer their risk potential for specific STIs. If the answer is affirmative, then ask the patient when she/he had the STI, where she/he was treated, and if the treatment regimen was completed. Ask whether partner's) were treated as well. Just because a patient is middle aged or older does not mean he or she is not at risk for HIV/AIDS. Approximately 10 percent of all AIDS cases in the U.S. are among those 50 years and older. Asking about HIV/AIDS is a good way to encourage patients to evaluate their own risk behaviors and assess whether they are adequately protecting themselves from other STIs as well. This also allows the clinician to assess the patient’s understanding of risks and protective measures. - - - Original content for this slide submitted by the Clinical Advisory Committee for the Mature Sexuality Education Initiative in March 2004. Original funding received from GlaxoSmithKline Consumer Health, Pfizer Women’s Health, and Procter & Gamble Pharmaceuticals through unrestricted educational grants. Last reviewed/updated by Susan Kellogg-Spadt, PhD, CRNP, Sheryl A. Kingsberg, PhD, Kirtly Parker Jones, MD, and Beverly Whipple, PhD, RN, FAAN, in February 2007.
  • Talking Points: Avoid using the term “molested,” which may not be understood by some people. Don’t assume that only women are abused; always include history of sexual abuse and rape when taking a male patient’s sexual history. - - - Original content for this slide submitted by the Clinical Advisory Committee for the Mature Sexuality Education Initiative in March 2004. Original funding received from GlaxoSmithKline Consumer Health, Pfizer Women’s Health, and Procter & Gamble Pharmaceuticals through unrestricted educational grants. Last reviewed/updated by Susan Kellogg-Spadt, PhD, CRNP, Sheryl A. Kingsberg, PhD, Kirtly Parker Jones, MD, and Beverly Whipple, PhD, RN, FAAN, in February 2007.
  • Talking Points: The PLISSIT model offers an approach to communicating with patients about sexual concerns that allows the individual clinician to gear this communication to their own level of comfort, or competence. Theoretically, each descending level of this approach requires increasing degrees of knowledge, training, and skill on the part of the clinician, who determines at what point referral elsewhere is appropriate. Source : Annon JS. The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems. J Sex Ed & Ther 1976;2(2):1-15. - - - Original content for this slide submitted by the Clinical Advisory Committee for the Mature Sexuality Education Initiative in March 2004. Original funding received from GlaxoSmithKline Consumer Health, Pfizer Women’s Health, and Procter & Gamble Pharmaceuticals through unrestricted educational grants. Last reviewed/updated by Susan Kellogg-Spadt, PhD, CRNP, Sheryl A. Kingsberg, PhD, Kirtly Parker Jones, MD, and Beverly Whipple, PhD, RN, FAAN, in February 2007.
  • Talking Points: Giving information often goes hand in hand with giving permission. Frequently this information-giving can dispel myths or misconceptions, such as ones related to genital size. The information should be limited to specific facts directly relevant to the patient’s particular concern. The clinician’s ability to use this approach will depend on their knowledge, theoretical orientation, and value system. Source : Annon JS. The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems. J Sex Ed & Ther 1976;2(2):1-15. - - - Original content for this slide submitted by the Clinical Advisory Committee for the Mature Sexuality Education Initiative in March 2004. Original funding received from GlaxoSmithKline Consumer Health, Pfizer Women’s Health, and Procter & Gamble Pharmaceuticals through unrestricted educational grants. Last reviewed/updated by Susan Kellogg-Spadt, PhD, CRNP, Sheryl A. Kingsberg, PhD, Kirtly Parker Jones, MD, and Beverly Whipple, PhD, RN, FAAN, in February 2007.

Expedited Partner Therapy For Chlamydia Treatment Power Point  Flagstaff July 2009  June 30 Version (6) Expedited Partner Therapy For Chlamydia Treatment Power Point Flagstaff July 2009 June 30 Version (6) Presentation Transcript

  • Expedited Partner Therapy for Chlamydia Treatment July 25, 2009 Flagstaff, Arizona Jo Ann Woodward WHNP-BC www.joannwoodward.com
  • Communicating with Patients about Sexuality www.joannwoodward.com Be a sympathetic listener Reassure the patient Make a referral
  • Assessing STI Risks
    • Evaluate all patients for risks of sexually transmitted infections (STIs), including AIDS.
    • Don’t make assumptions
    www.joannwoodward.com 
  • Assessing STI Risk www.joannwoodward.com “ Have you ever had a sexually transmitted infection?” “ What steps or precautions do you take during sexual activity to prevent transmission of diseases?”
  • Assessing Abuse www.joannwoodward.com “ Have you ever been forced to have sex against your will?” “ Did anyone ever touch you, or make you touch them, in a way that made you feel uncomfortable?” “ Has anyone ever battered you or hit you?” “ Do you live with anyone who verbally abuses you?”
  • The PLISSIT Model www.joannwoodward.com Annon JS. J Sex Ed & Ther. 1976. L imited I nformation S pecific S uggestions I ntensive T herapy P ermission
  • PLISSIT Level Two: Limited Information www.joannwoodward.com “… It is not at all uncommon for men and women in their 60s and 70s to have sexual intercourse on a regular basis.” Annon JS. J Sex Ed & Ther. 1976. Annon JS J Sex Ed & Ther. 1976
  • Chlamydia -The Current Problem An Introduction of this issue
    • The Reported Year 2007
    • The reported occurrence - 1.1 million cases of Chlamydia : reported to the Centers for Disease Control and Prevention.(CDC )
    • The ages at risk :females aged 16-25 years of age.
    • Source : Sexually transmitted disease surveillance , 2007, CDC
    www.joannwoodward.com
  • A brief description of the policy and its development
    • Expedited Partner therapy allows a patient to receive treatment for Chlamydia.
    • Expedited Partner Therapy (EPT) is the clinical service of treating the partners of patients diagnosed with Chlamydia by providing prescriptions or medications to the patient to take to their partner without the health care provider first examining the partner.
    www.joannwoodward.com
  • When One STI is present- Look and Ask for More www.joannwoodward.com
    • In Arizona: The stakeholders as funders.
    • Twelve Medicaid plans reported an increase of Chlamydia trachomatis screening in sexually-active females 16-25 years old.
    • Chlamydia screening increased from 23.3% to 77.7%, from 2000 to 2007.
    • Source :Healthcare Effectiveness Data and Information Set, United States, 2000-2007
    www.joannwoodward.com
  • Benefits of Expedited Partner Therapy (EPT)
    • Facilitate partner referral among heterosexual men and women.
    • Prevent re-infection of patients with Chlamydia.
    • EPT is at least equivalent in efficacy to standard partner management for Gonorrhea and Chlamydia.
    • EPT is a cost-saving and cost-effective partner management strategy.
    www.joannwoodward.com
  • Treatment Options
    • Provider delivered Therapy
    • Patient delivered partner therapy
    • Health department treatment
    • Anonymous Computer notification
    www.joannwoodward.com
  • How does this policy inform your practice?
    • Expedited Partner Therapy ( EPT) intended for female partners is accompanied by warnings about the symptoms of Pelvic Inflammatory Disease (PID).
    • Medico legal ramifications may be uncertain in the event of adverse outcomes in the recipients of EPT .
    • Risks of allergic reactions and other adverse drug effects.
    • Administrative barriers such as not providing the medication to the partner. Currently, it is written in a prescription.
    www.joannwoodward.com
  • www.joannwoodward.com
  • A sample In Spot card
    • In spot provides electronic assistance to patients interested in using technology to notify their partners. This program allows infected patients to notify their partners of the need for testing and treatment by sending them a text message or an e-mail. This can be signed or anonymous. These cards vary from cordial to rude .In spot messages can also be very sensitive depending on the viewer’s choice of card. A sample is provided above.
    www.joannwoodward.com
  • www.joannwoodward.com
  • Treatment Recommendations
    • Zithromax Gram 1 ,given as a suspension in water or as four capsules by mouth (p.o.) each with 250 mg.to be taken at once.
    • EPT should be accompanied by information to advise recipients to seek personal health care in addition to EPT. This is particularly important when EPT is provided to male patients for their female partners, and for male partners with symptoms.
    www.joannwoodward.com
  • CDC Guidelines Chlamydia Treatment
    • Recommended Regimens Azithromycin 1 g orally in a single dose     OR Doxycycline 100 mg orally twice a day for 7 days
    • Alternative Regimens Erythromycin base 500 mg orally four times a day for 7 days     OR Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days     OR Ofloxacin 300 mg orally twice a day for 7 days     OR Levofloxacin 500 mg orally once daily for 7 days
    www.joannwoodward.com
  • Chlamydia Treatment in Pregnancy
    • Pregnancy. Doxycycline, ofloxacin, and levofloxacin are contraindicated in pregnant women. However, clinical experience and studies suggest that azithromycin is safe and effective .
    • Repeat testing (preferably by NAAT) 3 weeks after completion of therapy with the following regimens is recommended for all pregnant women to ensure therapeutic cure, considering the sequelae that might occur in the mother and neonate if the infection persists. The frequent gastrointestinal side effects associated with erythromycin might discourage patient compliance with the alternative regimens.
    • Recommended Regimens:
    • Azithromycin 1 g orally in a single dose     OR Amoxicillin 500 mg orally three times a day for 7 days
    • Alternative Regimens Erythromycin base 500 mg orally four times a day for 7 days OR Erythromycin base 250 mg orally four times a day for 14 days OR Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days OR Erythromycin ethylsuccinate 400 mg orally four times a day for 14 days
    www.joannwoodward.com
  • Future Policy Directions:
    • Ongoing evaluation is needed to define when and how EPT can be best utilized for patients.
    • EPT represents an additional strategy to embrace the lateral resource pool for partner management that does not replace other strategies, such as standard patient referral or provider-assisted referral, when available.
    • EPT may replace conventional strategies in the adolescent population if notification can be significantly improved.
    • Sources: Golden, MR. (2001).
    • Unterschuetz,C. (2008).
    www.joannwoodward.com
  • Check From Top to Bottom www.joannwoodward.com
  • A Nurse Practitioner, Nurse Midwife and Physician Collaboration www.joannwoodward.com
  • Let’s Work Together to Avoid Painful Neonatal Herpes www.joannwoodward.com
  • www.joannwoodward.com                                      LOS ANGELES – By SHAYA TAYEFE MOHAJER, Associated Press Writer Los Angeles county health officials are offering a free, at-home program to test for sexually transmitted diseases. All women in the county can request free test kits that detect Chlamydia or gonorrhea infection by visiting a Web site or calling a toll-free number. The kits are then mailed to the women's homes. The program is intended to eliminate clinic waits or costs and targets young women of color. There will be 10,000 kits available immediately. According to the Centers for Disease Control and Prevention, Los Angeles County ranks first in the nation in the number of Chlamydia cases, and second in gonorrhea cases. LA County says it will pass out mail-in STD tests
  • www.joannwoodward.com Teenage girls are now a text message away from finding out whether they have sexually transmitted diseases (STD). Health officials in Los Angeles County unveiled a program that will target young women by offering home delivery of STD testing kits and a text message to alert them when the results are ready online. Health officials hope their program can curb the alarming spread of gonorrhea and Chlamydia. Offers Home Delivery Of Chlamydia, Gonorrhea Test Kits L.A. County, Calif.
  • Call 1800 758 0880 in Los Angeles County
    • Order Now
    • Already a user? Login here
    • If you are a woman age 12 to 25 and you live in Los Angeles County, you can get a free home test kit for Chlamydia and gonorrhea. Just fill out the form below to get a test kit sent to you.  It will arrive in a plain white envelope in 3 to 5 days. Take the test and mail it back in the pre-paid envelope.  Then pick up your results at this website or by phone in one week. The kit and the test are free – including postage!
    • This test is for women who don't have any signs or symptoms of an STD.  Most women with Chlamydia or gonorrhea have no signs or symptoms and don’t know they are infected. If you think you are having signs or symptoms of an STD, don’t order the kit -- please go to a clinic right away to get checked.
    • Reference: https://www.dontthinkknow.org/get-a-home-test-kit/order-now.html
    www.joannwoodward.com
  • References:
    • Arizona Department of Health Services. (n.d.). Retrieved March 17, 2009, from http://www.azdhs.gov/phs/oids/std/pdf/Expedited%20Partner%20Therapy%20Chlamydia%20-%20English.pdf
    • CDC. Sexually transmitted disease surveillance, 2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2009.(n.d.) Retrieved April 10,2009, from http://www.cdc.gov/std/stats07/toc.htm .
    • Golden, MR, Whittington, WLH, Handsfield, HH, et al. (2005). Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or Chlamydia infection. New England Journal of Medicine; 352, 676-685.
    • Golden, MR, Whittington WLM, Handsfield HH, et al. (2001). Partner management for gonococcal and chlamydial infection: Expansion of public health services to the private sector and expedited sex partner treatment through a partnership with commercial pharmacies. Sexually Transmitted Diseases, 26:658-665.
    www.joannwoodward.com
  • References:
    • http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf
    • In SPOT - [STD] Internet Notification Service for
    • Partners or Tricks. (n.d.). Retrieved April 10,
    • 2009, from http Int ://www.inspot.org/gateway.aspx .
    • Nelson, A., & Woodward, J. (2006). Sexually Transmitted diseases a practical guide for primary care. New York, NY: Springer.
    • Unterschuetz, C, Hughes,P.,Nienhauser,D.,Weberg, D.,Jackson,L. (2008). Caring for innovation and caring for the innovator. Nursing Administration Quarterly, 32 (2), pp. 133-141 .
  • Never Stop Asking
    • Everyone needs Help
    • Call 24 hours a day
    • 1-800-227-8922
    • Log On www.asha.org
    www.joannwoodward.com