Barriers to and Facilitators of Expedited Partner Therapy in US Emergency Departments: A Qualitative Study

Abstract

Objectives:

Expedited partner therapy (EPT) provides treatment or prescriptions for the sexual partners of patients with sexually transmitted infections (STIs) without requiring a clinical visit, and it is recommended for partners who might not seek care otherwise. Despite its public health importance, EPT has had limited uptake in emergency departments (EDs). We assessed barriers to and facilitators of EPT that could assist in increasing its use in EDs.

Methods:

From July 2020 through February 2021, we conducted semistructured virtual interviews with 18 ED medical directors and key medical personnel from US institutions that offer or were interested in offering EPT, as identified through previous research. We developed and piloted an interview guide based on the Consolidated Framework for Implementation Research. We recorded, transcribed, and analyzed interviews using thematic analysis. We developed themes through iterative coding and team discussion.

Results:

Participant-reported barriers to implementing EPT included perceived legal liability, unclear clinical workflows, electronic health record challenges when prescribing for a nonpatient, ambiguity about duty to the sexual partner, concerns about patient safety, and sexual health stigma. Facilitators were defined as task sharing, streamlined electronic health record processes, and leadership support. Participants emphasized the ED’s potential to expand access to care for populations at high risk for STIs, provided that EPT implementation did not disrupt clinical operations.

Conclusions:

Understanding barriers to and facilitators of EPT in EDs can inform the development of effective implementation strategies. While nontraditional prescribing processes pose challenges to routine adoption of EPT, experiences from EDs with established protocols suggest that these obstacles can be overcome.