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Expedited Partner Therapy


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Expedited Partner Therapy

  1. 1. Expedited Partner Therapy Charlie Rabins, MPH Illinois Department of Public Health Sexually Transmitted Diseases Program Illinois Hospital Association Webinar December 8, 2009
  2. 2. Overview and Purpose <ul><li>What is Expedited Partner Therapy (EPT) </li></ul><ul><li>Why EPT is Needed in Illinois </li></ul><ul><li>Highlights of Illinois EPT Legislation </li></ul><ul><ul><li>Senate Bill 0212/Public Act 096-0613 </li></ul></ul><ul><ul><li>Effective January 1, 2010 </li></ul></ul><ul><li>How Hospitals can Help in STD Prevention </li></ul><ul><li>Questions from Webinar Participants </li></ul>
  3. 3. What is Expedited Partner Therapy (EPT) <ul><li>To prescribe, dispense, furnish or otherwise provide prescription drugs to the sex partner or partners of persons diagnosed with STDs without physical examination of the partners </li></ul>
  4. 4. Purpose and Goals of EPT <ul><li>Purpose: to treat partners of clients with chlamydia and/or gonorrhea who are unable or unlikely to seek medical care </li></ul><ul><li>Goals: </li></ul><ul><ul><li>Decrease new CT/GC infections in community </li></ul></ul><ul><ul><li>Reduce CT/GC re-infection rates </li></ul></ul><ul><ul><li>Decrease complications from untreated CT and GC </li></ul></ul>
  5. 5. EPT Usage in U.S. <ul><li>EPT is a standard of care and supported by AMA </li></ul><ul><ul><li>In 2006, CDC issued an EPT guidance, concluding that EPT is a useful option to facilitate partner management - especially for the treatment of male partners of women with chlamydia and/or gonorrhea </li></ul></ul><ul><li>EPT has been proven to be safe and effective </li></ul><ul><ul><li>Adverse reactions to antibiotics are rare </li></ul></ul><ul><ul><li>No reports in California since implementing EPT in 2001 </li></ul></ul><ul><li>EPT is currently legal in 20 states </li></ul>
  7. 7. Illinois Chlamydia Cases By Sex 1990 - 2008 Cases
  8. 8. Gonorrhea Illinois 1986 - 2008 Cases
  9. 9. Reported Chlamydia & Gonorrhea Cases by Age Group Illinois 2008 Chlamydia Gonorrhea
  10. 10. Illinois Reported STD Case Rates Disparity Between Racial/Ethnic Groups, 2008 *Primary and Secondary African Americans Whites Hispanics Disparity: African Americans vs. Whites Disparity: Hispanics vs. Whites Chlamydia 1,787 123 542 14.6 X 4.4 X Gonorrhea 837 24 102 35 X 4.2 X P/S* Syphilis 14 2 7 7 X 3.5 X
  11. 11. 2008 Illinois Chlamydia Rates Rate per 100,000 Population >=400 14 - 99 200 - 399 100 - 199 0
  12. 12. >300 > 100 - 300 0 >0 - 100 Rate per 100,000 Population 2008 Illinois Gonorrhea Rates
  13. 13. Re-infection Rates for Chlamydia <ul><li>Re-screening project in Illinois in 2006 indicated 16 % of female clients at selected provider types were re-infected within six months of prior treatment </li></ul><ul><li>National studies - 15-25 % CT re-infection </li></ul><ul><li>Re-infection attributed primarily to untreated partners </li></ul><ul><li>Illinois Department of Public Health (IDPH) recommends re-screening all females and males 3 to 4 months after treatment for chlamydia and gonorrhea </li></ul>
  15. 15. Highlights of Illinois EPT Law - 1 <ul><li>Overwhelming Support in Legislature </li></ul><ul><li>Amends </li></ul><ul><ul><li>Illinois STD Control Act (410 ILCS 325/3) </li></ul></ul><ul><ul><li>Medical Practice Act (225 ILCS 60/64) </li></ul></ul><ul><ul><li>Nurse Practice Act ((225 ILCS 65/70-170) </li></ul></ul><ul><ul><li>Physician Assistant Practice Act (225 ILCS 95/25) </li></ul></ul><ul><li>Defines EPT </li></ul><ul><ul><li>Prescribe, dispense, furnish or otherwise provide prescription antibiotic drugs to sex partners (within the past 60 days) of persons clinically diagnosed with chlamydia or gonorrhea without physical examination of the partners, if in the judgment of the health care professional, the sex partner is unlikely or unable to present for comprehensive evaluation, testing and treatment </li></ul></ul>
  16. 16. Highlights of Illinois EPT Law - 2 <ul><li>Stipulates Which Health Care Professionals (HCP) can Provide EPT </li></ul><ul><ul><li>Licensed physician (practice medicine in all its branches) </li></ul></ul><ul><ul><li>Physician assistant delegated to provide STD therapy or EPT by supervising physician </li></ul></ul><ul><ul><li>Advanced practice nurse with a written collaborative agreement with a collaborating physician that authorizes STD therapy or EPT </li></ul></ul><ul><ul><li>Advanced practice nurse who practices in a hospital or ambulatory surgical treatment center and possesses appropriate clinical privileges in accordance with the Nurse Practice Act </li></ul></ul>
  17. 17. Highlights of Illinois EPT Law - 3 <ul><li>Liability Protections for HCPs </li></ul><ul><ul><li>EPT provided to sex partners in good faith without fee or compensation where counseling and written materials are provided is not subject to civil or professional liability except for willful and wanton misconduct </li></ul></ul><ul><ul><li>Choosing not to provide EPT has the same exemption from liability </li></ul></ul><ul><li>Liability Protections for Pharmacists/Pharmacists </li></ul><ul><ul><li>Not subject to civil or professional liability for choosing not to fill a prescription that would cause them to violate any provision of the Pharmacy Practice Act </li></ul></ul>
  18. 18. <ul><li>Identifies Responsibilities of HCPs Providing EPT </li></ul><ul><ul><li>Counsel infected patients </li></ul></ul><ul><ul><li>Provide written materials on EPT (developed by IDPH) to patients to give to their sex partners receiving EPT </li></ul></ul><ul><li>Requirements Related to Counseling and Written Materials </li></ul><ul><ul><li>Warnings related to pregnancy (antibiotics and need for HCP examination) </li></ul></ul><ul><ul><li>Information about provided or prescribed antibiotics and dosage (allergy warnings and need for HCP examination) </li></ul></ul>Highlights of Illinois EPT Law - 4
  19. 19. <ul><li>Requirements Related to Counseling and Written Materials - Continued </li></ul><ul><ul><li>Information about treatment and prevention of STDs </li></ul></ul><ul><ul><li>Requirement of abstinence until a period of time after treatment </li></ul></ul><ul><ul><li>Importance of receiving examination and testing for HIV and other STDs and available resources </li></ul></ul><ul><ul><li>Risk to self, others and public health if the STD is not completely/successfully treated </li></ul></ul><ul><ul><li>Responsibility of the sex partner to inform their sex partners of the risk of STDs and prompt exam/treatment </li></ul></ul><ul><ul><li>Other information as required by IDPH </li></ul></ul>Highlights of Illinois EPT Law - 5
  20. 20. <ul><li>Responsibility of Illinois Department of Public Health (IDPH) to develop and disseminate in electronic and written format: </li></ul><ul><ul><li>Informational materials for sex partners </li></ul></ul><ul><ul><li>Informational materials for STD repeaters </li></ul></ul><ul><ul><li>Guidance for HCPs on EPT </li></ul></ul><ul><li>IDPH May Offer Educational Programs about EPT for HCPs and Pharmacists </li></ul>Highlights of Illinois EPT Law - 6
  21. 21. EPT Barriers and Challenges <ul><li>Medication and prescription labeling </li></ul><ul><li>Adverse reactions/allergy – rare </li></ul><ul><li>EPT may compromise quality of care </li></ul><ul><ul><li>Appropriate care – seek comprehensive services </li></ul></ul><ul><ul><li>Ideally partners receiving EPT will access care </li></ul></ul><ul><li>Benefits of EPT outweigh the risks </li></ul><ul><ul><li>Doing nothing may result in: </li></ul></ul><ul><ul><ul><li>Re-infection and further community transmission </li></ul></ul></ul><ul><ul><ul><li>Complications: pelvic inflammatory disease, ectopic pregnancy, infertility, epididymitis </li></ul></ul></ul><ul><li>Risks offset by patient education, written materials and encouraging a visit to HCP </li></ul>
  22. 22. EPT Implementation <ul><li>EPT law effective date: January 1, 2010 </li></ul><ul><li>IDPH drafting </li></ul><ul><ul><li>Guidance for Illinois Health Care Professionals </li></ul></ul><ul><ul><li>Patient and Partner Information sheets </li></ul></ul><ul><ul><li>HCP Fact Sheet </li></ul></ul><ul><ul><li>STD Repeater Information Sheet </li></ul></ul><ul><li>Materials will be available: </li></ul><ul><ul><li>IDPH Internet </li></ul></ul><ul><ul><li>IDPH STD Program </li></ul></ul><ul><ul><li>Health Care Organizations and Associations </li></ul></ul>
  23. 23. Importance of Hospitals in STD Prevention and Treatment in Illinois Number and Percent of Reported Cases of STDs in Illinois from Hospitals in 2008 Chlamydia Gonorrhea Early Syphilis Number of Reported Cases all Provider Types 59,169 20,674 825 Number of Reported Cases From Hospitals 14,264 6,807 221 Percent Total Cases Reported From Hospitals 24% 33% 27%
  24. 24. Preventing STDs How Hospitals Can Help <ul><li>Conduct sexual history whenever feasible </li></ul><ul><li>Screen all sexually active females under 26 years of age for chlamydia and gonorrhea at least annually </li></ul><ul><li>Screen females 26 years of age and older for chlamydia and gonorrhea based on risk factors </li></ul><ul><ul><li>symptoms and sex partner history </li></ul></ul><ul><li>Conduct diagnostic testing and presumptive treatment when STDs are suspected </li></ul><ul><li>Counsel infected persons, provide EPT and recommend sex partner notification and referral </li></ul>
  25. 25. EPT On-Line Resources <ul><li>IDPH Website (EPT HCP Guidance , Patient and Partner Written Materials will be Available by 1/1/2010) </li></ul><ul><ul><li> </li></ul></ul><ul><li>Illinois EPT Law (SB 0212, PA 69-613): </li></ul><ul><ul><li> </li></ul></ul><ul><li>CDC </li></ul><ul><ul><li>EPT website: </li></ul></ul><ul><ul><li>CDC white paper: </li></ul></ul>
  26. 26. Questions Charlie Rabins Chief, STD Section Illinois Department of Public Health [email_address] 217-782-2747