Candy Hadsall RN MA MN Department of Health Daniel Jude PharmD AAHIVP CSP TrellisRx North Memorial Health So whats the problem Total of 32024 STD cases reported to MDH in 2018 23564 Chlamydia CT cases ID: 1042721
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1. Expedited Partner Treatment for STDsCandy Hadsall, RN, MA, MN Department of HealthDaniel Jude, PharmD, AAHIVP, CSP TrellisRx/North Memorial Health
2. So what’s the problem?Total of 32,024 STD cases reported to MDH in 2018:23,564 Chlamydia (CT) cases14,448 cases (62%) in 15-24 year olds7,542 Gonorrhea (GC) cases918 Syphilis cases (all stages)0 Chancroid cases286 HIV cases (not part of 32,024)Trends for CT and GC cases ages 15-24:61% CT, 43% of GC cases72% were femalesWhite 39%, Black 26%17% in Minneapolis, 12% St Paul, suburbs 34%, Gr MN 36%Data Source: Minnesota STD Surveillance System 2018 STDs in Minnesota: Annual Review
3. What’s (one of) the solution?Expedited Partner Therapy (EPT):Treatment for CT and/or GC in sexual partners without clinic visit or being seen by providerPatient Delivered Partner Therapy (PDPT): Delivery of prescription or medication by original patient to her/his partner(s) 43 states, including MN (the legal part is already done!!)Why EPT?Increasing need for STI prevention (record highs in 2018)Partner management is cornerstone of STI preventionPartners often go untreated/high risk for re-infection
4. But this doesn’t sound legal!Oh, but it isPharmacy Statute: 151.37 § 2.g “Nothing in this chapter prohibits a licensed practitioner from issuing a prescription or dispensing a legend drug in accordance with the Expedited Partner Therapy in the Management of Sexually Transmitted Diseases guidance document issued by the United States Centers for Disease Control.”https://www.cdc.gov/std/treatment/eptfinalreport2006.pdfLots and lots of data and analysisThe partners are allowed to provide further info, like insurance info and demographics, to allow for billing
5. So what are the treatment options? And who do we treat?Treatment OptionsPartners of all patients diagnosed with CT and/or GC:Azithromycin 1 Gm orally x 1 PLUSCefixime (Suprax) 400 mg. orally x 1 (reserved for GC, no other cephalosporins will cover GC)No limit to # of partnersPopulationAny adult EXCEPTPregnant partners of malesMen who have sex with men (MSM)Allergies to antibioticsWorks best when:Partner(s) unlikely to seek careOther management options don’t work**STILL PREFER CLINICAL EVAL
6. But what about drug allergies?!Anaphylaxis to macrolides has been very rarePeople with allergy to penicillin Anaphylaxis with cephalosporins is extremely rare (0.1-0.0001%) ~10% of people report having a PCN allergy Cross reactivity to 3rd gen cephalosporins 1-3% Only avertable reactions are those occurring in persons with a known allergy who take meds despite written warnings No cases anaphylaxis to date in CA and WA
7. What are the barriers to making EPT a thing?Patient Level:Noncompliance (though single dose is helpful)May not give Rx to partnerMay resume sex <7 days after both treatedNew partnersStigma associated with STI-treatment and sexuality in generalSystem Level:Reimbursement/insuranceAvailability of cefiximeKnowledge of programPharmacy Level:Handling an Rx without patient-specific infoCharging cash priceKnowledge of programStigma from pharmacy staff
8. So who’s doing this?Health Systems are best equipped for thisNon-profit status allows a great public-health focusSystem policies to ensure everyone is aware of EPTProcesses built to handle billingAssigned to specific accountTypically less costly generics at health-systemsEasier to justify right-offClinic can readily coordinate with pharmacy to ensure adherence
9. You better have some best practices for us…We do!Create an EPT patient that everyone knows existsThis enables the pharmacist to record the work in their dispensing software in a standardized wayCreate and distribute an info sheet to put in the bag with the medicationThis gives each pharmacy the chance to address counseling if neededWork with local family medicine and sexual health clinics so they know the cost of the medsWithout an insurance plan to bill, there isn’t a good way to bring down costs; make sure referring clinics are aware of the situationEDUCATE, EDUCATE, EDUCATEMake sure clear processes and policies are available for all staff so they know how to handle the orders for EPT
10. I’m so excited to help! What can I do now?Save this sheet and download a copy of the presentationAdvocate for a standard process in your pharmacy practice settingBe prepared to educate your peers and staffReach out to sexual health clinics in your area; see if the providers offer EPTWork with your pharmacy network to learn who has Cefixime and how to get it quickly if needed
11. So what barriers do I have in my own setting?Example: what to say to person who comes in with no name on prescription blank to get them to give us that information?Others:
12. Who should I contact for support/issues? Candy Hadsall – candy.hadsall@state.mn.us651-201-4015Daniel Jude – daniel.jude@northmemorial.com763-581-3886