DISCUSSION
EPT, gonorrhea, chlamydia
REINFECTION, GONORRHEA
This pilot study demonstrates the feasibility of a novel ED-based, EPT take-home medication pilot program and the effectiveness of EHR interventions to facilitate adoption. We examined EPT use among all patients being presumptively treated for gonorrhea or chlamydia, as well as the efficacy of an interruptive BPA for EPT. While the BPA greatly increased EPT prescribing, EPT was only offered to 25% of EPT-eligible ED patients. This low level of EPT prescribing was surprising, especially given that most interviewees accurately conveyed the concept of EPT and supported its provision from the ED.The low level of EPT ordering may be due to several factors. First, there was an educational gap in how to order EPT; half of the participants stated that they did not know how to order EPT. Second, patients offered EPT may have declined, which this study could not measure. In a survey of pediatric ED patients, participants uninterested in EPT cited that they were concerned for partner safety, wanted the partner to get a diagnosis, or felt EPT would detract from the partner’s accountability.In the future, this will be an essential consideration, as delays in providing the medication in hand are a potential back-end issue. Addressing this concern may not only increase order rates among clinicians but increase efficiency and prevent delays in care. Fourth, emergency clinicians could have forgotten to prescribe EPT, as evidenced by interviewees who reported that remembering to prescribe EPT was challenging. The interruptive BPA likely reduced this issue. The non-interruptive BPA in the Discharge Navigator used in this project was probably overlooked, as none mentioned seeing it.Despite mixed feelings among clinicians toward BPAs in general, the majority supported an EPT-specific BPA, with nearly half suggesting using a BPA to increase EPT ordering. Further, the over two-fold increase in EPT ordering during BPA-exposed visits supports its efficacy for EPT implementation. This study adds to the growing research on clinician acceptabilityOnly three patients out of the 13 provided EPT had a lab-confirmed STI, suggesting presumptive EPT may lead to overprescribing. A potential solution to improve the accuracy of ED-based EPT provision is rapid testing for chlamydia and gonorrhea.An innovative aspect of this EPT program was the ability to provide “take-home” EPT kits. While EPT has been demonstrated to increase follow-up rates with the index patient’s partner and reduce reinfection rates among the index patient,Although other ED “take-home” medications may be charged to a patient’s healthcare insurance plan, this mechanism is not currently possible for EPT, as most health insurers will not pay for medication for anyone other than the covered individual. One known exception is California, where, since February 2020, the state Medicaid provider – including Medi-Cal and Family PACT insurance – must cover partner EPT medications for low-income patients.