PC2007: Knowledge and Practices Regarding Expedited Partner Therapy for Adolescents in Children’s Hospital Associated Clinicians in Connecticut

Background: There is limited use of expedited partner therapy (EPT) among adolescents with sexually transmitted infections. The CDC recommends offering EPT to patients with chlamydia and/or gonorrhea when the provider cannot ensure that the patient’s sex partners from the previous 60 days will seek timely treatment. Further, individual states have differing guidelines regarding EPT prescribing. In Connecticut (CT), guidelines specify use for both gonorrhea and chlamydia, and that only the partner’s full name is required for prescribing. Previous research has identified lack of familiarity with state-specific guidelines as barriers to EPT, however, the extent of this knowledge gap among children’s hospital associated pediatric clinicians in CT is unknown.

Methods: The objectives of this study are to determine the baseline knowledge of current CT EPT guidelines at two academic pediatric hospitals. We further sought to describe usual practice patterns and identify potential barriers to prescribing EPT for adolescents. A cross-sectional, anonymous, self-administered online survey was designed with 11 questions addressing knowledge and 12 questions addressing practice patterns. Face validity was established with input from 4 adolescent providers. The survey was provided to trainees (residents/fellows), advanced practice providers, and attending physicians in the ambulatory and emergency departments associated with Yale University and Connecticut Children’s Medical Center. Provider comfort discussing and providing EPT was evaluated with a Likert scale from 1 (very uncomfortable) to 5 (very comfortable). Chi-square analysis was used to evaluate responses between groups.

Results: To date, a total of 106 surveys have been completed for a response rate of 44%. Although most respondents (83%) reported caring for an adolescent with gonorrhea and/or chlamydia, only 34% of all respondents reported learning about EPT during their training. No provider correctly answered all knowledge questions. Respondents demonstrated knowledge gaps with frequent incorrect (20%) or unsure (29%) responses. In many cases, respondents selected “not sure” for knowledge questions related to treatment for a presumptive diagnosis, (60.4%), the sole requirement for a partner’s full name (42.6%), the need to obtain partner’s birthday (47.5%), and the need to provide a prescription information sheet (46.5%). The mean provider comfort for prescribing EPT was 2.98 (neither comfortable nor uncomfortable) with a standard deviation of 1.3. There was no difference in knowledge base on training level (p=0.762) or affiliated department (p=0.431). Reported barriers to prescribing EPT include being unfamiliar with the process of prescribing (53%), patient refusal (12%) and patient not knowing/providing the partner’s name (9%).

Conclusion: In CT, provider knowledge of EPT is limited regardless of level of training or department affiliation, resulting in underuse of EPT in the adolescent population. The most common barrier to prescribing EPT was lack of knowledge with the prescribing process. This data indicates the importance of intergenerational education about use of EPT.