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Patient-delivered partner therapy for chlamydia infections

Patient-delivered partner therapy for chlamydia infections. Attitudes and practices of California physicians and nurse practitioners. Speaker: Laura Packel Co-Authors: Sarah Guerry, Heidi Bauer, Miriam Rhew, Gail Bolan

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Patient-delivered partner therapy for chlamydia infections

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  1. Patient-delivered partner therapy for chlamydia infections Attitudes and practices of California physicians and nurse practitioners Speaker: Laura Packel Co-Authors: Sarah Guerry, Heidi Bauer, Miriam Rhew, Gail Bolan Sexually Transmitted Disease Control Branch, CA Department of Health Services 2004 National STD Prevention Conference March 11, 2004

  2. Background • More than 110,000 CT infections were reported in California in 2002. • Repeat CT infection increases risk for adverse health outcomes • Untreated partner is a risk for repeat infection • Allowing patient to deliver antibiotics to sexual partner(s) may facilitate partner treatment and reduce re-infection

  3. Background • New California law allowing patient-delivered partner therapy (PDPT) passed in January of 2001

  4. Implementation of PDPT legislation • California Department of Health Services guidelines for implementation of PDPT • Newsletter articles • Provider education and training

  5. Survey Objectives • To examine attitudes and practices around PDPT among clinicians in California • To determine areas for intervention with the goal of increasing appropriate use of PDPT in California

  6. Survey Sample and Design • Cross-sectional, self-administered, mailed survey of primary care providers (medical doctors & nurse practitioners) in California • Medical Doctors (MDs): stratified random sample of MDs in California, 400 per primary care specialty, plus all 68 adolescent medicine providers • Nurse Practitioners (NPs): All 1,815 primary care NP members of California Coalition of Nurse Practitioners • Time frame: Dec 2001-March 2002

  7. Eligibility and Recruitment • Eligibility criteria: • Provide primary care to sexually active patients under the age of 30 in the past 3 months • Spend more than 10% of time providing clinical care • Exclusion criteria: • Not practicing within California • No valid mailing address • No valid phone number • Recruitment: • 3 mailings • fax and phone follow-up

  8. Analytic Methods • Main outcome of interest: reported routinely use of PDPT to male or female partners of CT cases • Routinely use of PDPT=‘usually’ or ‘always’ • Overall proportions for physicians weighted by medical specialty • NPs and MDs not combined because of differences in sampling • Pearson chi-squared, logistic regression used for statistical analysis

  9. Results: Response Rates • MD response rate: • 49%, 708/1456 eligible MDs • NP response rate: • 63%, 895/1418 eligible NPs

  10. MD and NP Respondent Demographics

  11. MD Respondents by Medical Specialty (n=708)

  12. Chlamydia Partner Management Practices *weighted

  13. Routine Use of PDPT: Overall MD and NP and by Medical Specialty *Weighted

  14. Barriers to PDPT • Agreement with the following statements: • Patient-delivered partner therapy for chlamydia… • Is an activity my practice may not get paid for • Is dangerous without knowing partner’s medical/allergy history • May get me sued • May result in incomplete care for the partner • Should only be for male partners of females • Should only be given if partner name is given

  15. → → → Provider Barriers to PDPT Strongly agree/agree (%) → Significant predictors of PDPT * weighted

  16. ← ← ← MD predictors of routine use of PDPT *Adjusted for volume of female patients per week, MD specialty and barriers

  17. ← ← ← NP predictors of routine use of PDPT *Adjusted for volume of female patients per week and barriers

  18. Conclusions • ~ 50% of CA MDs and NPs reported routinely use PDPT in practice • MDs: Significant differences between specialties in routine use of PDPT • For both MDs and NPs: reported concerns about PDPT were predictors of routine use of PDPT

  19. Conclusions: Most Common Barriers • Incomplete care for partner • Practice may not be reimbursed • Dangerous without knowing partner medical and/or allergy history

  20. Next Steps • Improve use of PDPT among MDs and NPs in California • Educate around potential barriers to PDPT may help increase routine use • Develop of more specific guidelines around PDPT use • Reimbursement mechanisms • CA Partner services evaluation ongoing

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