文章基本信息

标题：Expedited Partner Therapy for Sexually Transmitted Diseases: Assessing the Legal Environment
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作者：James G. Hodge Jr ; Amy Pulver ; Matthew Hogben 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：2
页码：238-243
DOI：10.2105/AJPH.2007.113381
语种：English
出版社：American Public Health Association
摘要：An emerging alternative to traditional partner management for sexually transmitted diseases (STDs) is expedited partner therapy (EPT), which involves the delivery of medications or prescriptions to STD patients for their partners without the clinical assessment of the partners. The Centers for Disease Control and Prevention recently recommended EPT nationally in limited circumstances; however, its implementation may raise legal concerns. We analyzed laws relevant to the distribution of medications to persons with whom clinicians have not personally treated or established a relationship. We determined that three fourths of states or territories either expressly permit EPT or do not expressly prohibit the practice. We recommend (1) expressly endorsing EPT through laws, (2) creating exceptions to existing prescription requirements, (3) increasing professional board or association support for EPT, and (4) supporting third-party payments for partners’ medications. DESPITE MAJOR ADVANCES and achievements in the detection, treatment, and prevention of sexually transmitted diseases (STDs) in the United States, infections such as chlamydia and gonorrhea remain significant public health challenges. The US Centers for Disease Control and Prevention (CDC) estimates (on the basis of data from 2000) that over 700 000 new cases of gonorrhea and 2.8 million new cases of chlamydia occur each year. 1 ^– 3 To prevent reinfection and curtail further transmission, the CDC recommends that clinical management of patients with STDs should include treatment of the patients’ current sexual partners. 4 Ensuring treatment of sexual partners has been a central component of STD prevention and control for decades. 5 ^, 6 Initially developed to help control syphilis, partner management became widely recommended for gonorrhea, chlamydial infection, and HIV infection. 7 ^, 8 However, with the exception of syphilis and sometimes HIV, partner management based on provider referral is rarely ensured for STDs, and patient referrals have only modest success in achieving partner treatment. 9 An alternative public health approach is expedited partner therapy (EPT). 3 ^, 10 EPT refers to the delivery of medications or prescriptions by persons infected with an STD to their sexual partners without prior clinical assessment of those partners. Clinicians (e.g., physicians, nurse practitioners, physician assistants, pharmacists, public health workers) provide patients with sufficient medication, directly or with prescription, for them and their partners and encourage patients to have their partners seek clinical assessment. After evaluating multiple studies involving EPT, the CDC concluded that EPT is a “useful option” to promote partner treatment, particularly for male partners of women with chlamydial infection or gonorrhea. 10 In August 2006, the CDC recommended EPT as an option for certain populations with specific conditions. 4 Despite its endorsement, the CDC recognized numerous clinical factors or barriers to the practice of EPT, including (1) the potential for missed morbidity in partners who are treated without clinical evaluation, (2) concerns about adverse reaction to antibiotics, 11 ^, 12 and (3) the need for coordinated, systematic efforts by public health authorities, private sector clinicians and agencies, pharmacies, health insurers, and community-based organizations. In addition, implementation of EPT may raise legal questions and concerns in some settings. Central to these concerns is the perceived unauthorized distribution of prescriptions or medications to partners with whom clinicians have not personally evaluated or established a physician–patient relationship. In 2005, Golden et al. surveyed state boards of medicine and pharmacy and found that most boards (88%) perceived EPT as illegal or of “uncertain” legality, in part because the legal issues have “simply never been addressed.” 13 ^(p114) Beginning in September 2005, to assist state and local STD programs with EPT implementation efforts, we assessed the legal framework concerning EPT. Here, we discuss the legal issues underlying the practice of EPT, explain our methodology for the systematic examination of laws relevant to EPT, discuss major findings on the legality of EPT consistent with our examination, and provide legal and policy options for facilitating the implementation of EPT.