Downloaded from http://sti.bmj.com/ on June 20, 2015 - Published by group.bmj.com
STI Online First, published on March 19, 2015 as 10.1136/sextrans-2014-051873 Health services research
ORIGINAL ARTICLE
Healthcare providers’ perspectives on expedited partner therapy for chlamydia: a qualitative study Elian A Rosenfeld,1 John Marx,2 Martha A Terry,2 Ron Stall,2 Chelsea Pallatino,2 Elizabeth Miller3 1 VA Women’s Health, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA 2 Department of Behavioural and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 3 Division of Adolescent Medicine, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Correspondence to Dr E A Rosenfeld, VA Pittsburgh Healthcare System, University Drive C (151C) Building 30, Pittsburgh, PA 15240, USA; [email protected] Received 23 September 2014 Revised 27 January 2015 Accepted 22 February 2015
ABSTRACT Objectives Expedited partner therapy (EPT) effectively reduces rates of reinfection with chlamydia and increases the number of partners treated for the infection. Healthcare provider (HCP) provision of EPT is low. The objective of this qualitative study was to understand HCP views and opinions regarding the use of EPT in a state where EPT is permissible but underused. Methods Using a purposive sampling strategy to include diverse HCPs who treat young women at risk for chlamydia, 23 semistructured, in-depth interviews were conducted between October and December 2013. The interviews included questions about knowledge, attitudes, experiences with, and barriers and facilitators regarding the use of EPT. Results Many respondents report using EPT and believe the practice is beneficial for their patients. Most providers were unaware of their colleagues’ practices and had limited knowledge regarding institutional policies around EPT. HCPs noted a variety of barriers, such as fear of liability, confusion around the legal status of EPT and not being able to counsel patients’ partners that make routine use of this practice a challenge. Facilitators of EPT include speaking on the phone with patients’ partners and establishing legislation enabling EPT. Conclusions This is the first study to qualitatively examine HCPs’ perspectives on EPT in the USA. Barriers to EPT, including concerns about counselling patients’ partners and the legal status of EPT, can be overcome. EPT recommendations could include the use of phone calls as part of their guidelines. Changing EPT legislation at the state level in the USA is an important factor to facilitate EPT use.
INTRODUCTION
To cite: Rosenfeld EA, Marx J, Terry MA, et al. Sex Transm Infect Published Online First: [ please include Day Month Year] doi:10.1136/sextrans-2014051873
Chlamydia is a bacterial infection spread through sexual contact and is the most commonly reported infectious disease in the USA.1 Left untreated, chlamydia can cause pelvic inflammatory disease, ectopic pregnancy and infertility in women.2 Rates of reinfection are high, with 12–20% of women becoming reinfected with chlamydia within a year of their initial infection.3 Traditionally, healthcare providers (HCPs) encourage patients being treated for STIs to notify their sexual partners to seek treatment or may contact the patient’s sexual partners themselves.4 5 Research indicates that such approaches do not often result in treatment of partners.4 6 Even public health departments that have designated clinical staff to follow-up provide notification for 70% of family planning providers.16 A survey conducted in Arizona found that obstetricians/gynaecologists who received information about changes in state statutes about allowing EPT use were more likely to practise EPT.15 Participants spontaneously raised the issue of the potential harms of EPT, which has not been systematically reported in EPT trials to date. HCPs noted harms such as not being able to counsel patients’ partners, patients not giving their partners the medication and the possibility of intimate partner violence. While providers had positive perceptions of the benefits of EPT, they also have a number of concerns for the safety of their patients and their patients’ partners. Every form of partner notification has benefits and the potential for harm; a systematic review of randomised control trials on partner notification strategies, including EPT, found that the majority of trials do not report on or measure such harms.4 Further research on the potential magnitude of such harms should be considered, especially as EPT is disseminated in clinical practices. Several HCPs interviewed on their own determined that they preferred to speak to patients’ partners on the phone when providing EPT. HCPs sought ways to counsel patients’ partners about sexual behaviours, STIs and establish a provider–patient relationship; speaking to them on the phone was considered the most effective means to do so. Given that speaking on the phone to patients’ partners makes providers more comfortable using EPT, the CDC’s EPT recommendations could include the use of phone calls as part of their guidelines. In the UK, EPT is not permitted because patients must be medically assessed by providers before provision of medication.22 However, recently a form of EPT that complies with UK prescribing guidelines, accelerated partner therapy (APT), in which patients’ partners are either contacted via phone or receive consultation from a community pharmacist, has been assessed.22 Research has found that providers are willing to use APT and prefer the phone approach.23 Barriers and facilitators to using EPT centred around fears about being sued for adverse patient outcomes or being somehow liable for treating a patient they do not have a relationship with and the need to clarify the legality of EPT to 4
alleviate those fears. Our findings around barriers and facilitators to EPT were similar to the findings of studies conducted in the UK and Australia. A qualitative study conducted with general practitioners about their views on EPT and partner notification to treat chlamydia in Australia, a country that has no specific legislation about EPT, found that providers had concerns about treating a patient without evaluating their medical history and asserted that clarity around the legality of EPT would facilitate its use.24 A survey in the UK found that 22% of providers had used EPT, around one-third were opposed to the practice, providers felt that speaking on the phone with the partner was important, and the largest barrier to its use was the legality of EPT.25 This qualitative study demonstrates the way in which providers are willing to use EPT and have positive attitudes about the practice in a state where EPT is permissible but not expressly authorised. Barriers to EPT, including concerns about counselling patients’ partners and the legal status of EPT, can be overcome. Our study identified that providers have found ways to provide EPT in a manner they feel comfortable, by speaking to patients’ partner on the phone, enabling them to counsel patients’ partners. Providers desire clarity around the legal status of EPT; Pennsylvania could follow the lead of states such as California, New York and Arizona, and implement legislation that expressly allows EPT.20 Research is needed to examine how provider perspectives differ across states where EPT regulations differ. Further investigation should also quantify the frequency and impact of harms related to the provision of EPT. To make EPT more widely adopted, steps must be taken to ensure providers feel safe using this practice.
Key messages ▸ All participants felt that expedited partner therapy (EPT) would be a beneficial practice and something that would help reduce rates of reinfection with chlamydia for their patients. ▸ Participants noted barriers, including fear of liability and confusion around EPT’s legal status, and the harms of not being able to counsel patients’ partners. ▸ A facilitator of EPT involves speaking on the phone with patients’ partners; EPT recommendations could include the use of phone calls as part of their guidelines. ▸ Establishing specific legislation authorising EPT would facilitate its use.
Handling editor Jackie A Cassell Acknowledgements We would like to thank Carmel Shachar, JD MPH, staff attorney at Harvard Law School Center for Health Law and Policy Innovation, for her help in clarifying legal terms. Contributors ER conceived the study, designed the interview guide, conducted data collection for the whole study, wrote the analysis plan, analysed the data and drafted and revised the paper. JM designed the interview guide, monitored data collection, participated in interpretation of the results and revised the paper. MT designed the interview guide, participated in interpretation of the results and revised the paper. RS designed the interview guide and revised the paper. CP performed data analysis and participated in interpretation of the results. EM conceived the study, designed the interview guide, wrote the analysis plan, monitored data collection, participated in interpretation of the results and revised the paper. ER is the guarantor. Funding The Myrna Silverman Award and William Green Award from the University of Pittsburgh. Rosenfeld EA, et al. Sex Transm Infect 2015;0:1–5. doi:10.1136/sextrans-2014-051873
Downloaded from http://sti.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Health services research Competing interests None. Ethics approval The University of Pittsburgh Institutional Review Board.
12 13
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES 1 2
3
4
5 6
7
8
9
10
11
Centers for Disease Control Prevention. Sexually transmitted disease surveillance 2012. Atlanta: US Department of Health and Human Services, 2013. Walsh, Anderson LA, Irwin K. Observations from the CDC: the Silent Epidemic of Chlamydia trachomatis: the urgent need for detection and treatment in women. J Womens Health Gend Based Med 2000;9:339–43. Hosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis 2009;36:478–89. Ferreira A, Young T, Mathews C, et al. Strategies for partner notification for sexually transmitted infections, including HIV. Cochrane Database Syst Rev 2013;10: CD002843. Goldsworthy RC, Fortenberry DJ. Patterns and determinants of patient-delivered therapy uptake among healthcare consumers. Sex Transm Dis 2009;36:25–32. St. Lawrence JS, Montaño DE, Kasprzyk D, et al. STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians. Am J Public Health 2002;92:1784–8. Golden MR, Hogben M, Handsfield HH, et al. Partner notification for HIV and STD in the United States: low coverage for Gonorrhea, Chlamydial Infection, and HIV. Sex Transm Dis 2003;30:490–6. Centers for Disease Control and Prevention. Expedited partner therapy in the management of sexually transmitted diseases. Atlanta, GA: US Department of Health and Human Services, 2006. Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005;352:676–85. Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis 2003;30:49–56. Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis 2005;41:623–9.
Rosenfeld EA, et al. Sex Transm Infect 2015;0:1–5. doi:10.1136/sextrans-2014-051873
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15
16
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19 20 21 22
23
24
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Trelle S, Shang A, Nartey L, et al. Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review. BMJ 2007;334:354. Althaus CL, Turner K, Mercer CH, et al. Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling. Health Technol Assess 2014;18:1–100. Centers for Disease Control and Prevention. Guidance on the Use of Expedited Partner Therapy in the Treatment of Gonorrhea. 2012. http://www.cdc.gov/std/ept/ GC-EPT-GuidanceNov-2012.pdf (accessed 25 Nov 2014). Taylor M, Collier M, Winscott M, et al. Reticence to prescribe: utilization of expedited partner therapy among obstetrics providers in Arizona. Int J STD AIDS 2011;22:449–52. Jotblad S, Park IU, Bauer HM, et al. Patient-delivered partner therapy for chlamydial infections: practices, attitudes, and knowledge of California family planning providers. Sex Transm Dis 2012;39:122–7. Hogben M, McCree DH, Golden MR. Patient-delivered partner therapy for sexually transmitted diseases as practiced by US physicians. Sex Transm Dis 2005;32:101–5. Packel LJ, Guerry S, Bauer HM, et al. Patient-delivered partner therapy for chlamydial infections: attitudes and practices of California physicians and nurse practitioners. Sex Transm Dis 2006;33:458–63. Niccolai LM, Winston DM. Physicians’ opinions on partner management for nonviral sexually transmitted infections. Am J Prev Med 2005;28:229–33. Centers for Disease Control and Prevention. Legal Status of Expedited Partner Therapy. http://www.cdc.gov/STD/ept/legal/default.htm (accessed 25 Nov 2014). Boyatzis RE. Transforming qualitative information: thematic analysis and code development. Sage, 1998. Estcourt C, Sutcliffe L, Cassell J, et al. Can we improve partner notification rates through expedited partner therapy in the UK? Findings from an exploratory trial of Accelerated Partner Therapy (APT). Sex Transm Infect 2012;88:21–6. Shackleton T, Sutcliffe L, Estcourt C. Is Accelerated Partner Therapy partner notification for sexually transmissible infections acceptable and feasible in general practice? Sex Health 2011;8:17–22. Pavlin NL, Parker RM, Piggin AK, et al. Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners. BMC Infect Dis 2010;10:274. Shivasankar S, Challenor R. Patient-delivered partner therapy in the UK: what do the professionals think? Int J STD AIDS 2008;19:437–40.
5
Downloaded from http://sti.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Healthcare providers' perspectives on expedited partner therapy for chlamydia: a qualitative study Elian A Rosenfeld, John Marx, Martha A Terry, Ron Stall, Chelsea Pallatino and Elizabeth Miller Sex Transm Infect published online March 19, 2015
Updated information and services can be found at: http://sti.bmj.com/content/early/2015/03/19/sextrans-2014-051873
These include:
References Email alerting service
This article cites 20 articles, 5 of which you can access for free at: http://sti.bmj.com/content/early/2015/03/19/sextrans-2014-051873 #BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
STI Online First, published on March 19, 2015 as 10.1136/sextrans-2014-051873 Health services research
ORIGINAL ARTICLE
Healthcare providers’ perspectives on expedited partner therapy for chlamydia: a qualitative study Elian A Rosenfeld,1 John Marx,2 Martha A Terry,2 Ron Stall,2 Chelsea Pallatino,2 Elizabeth Miller3 1 VA Women’s Health, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA 2 Department of Behavioural and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 3 Division of Adolescent Medicine, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Correspondence to Dr E A Rosenfeld, VA Pittsburgh Healthcare System, University Drive C (151C) Building 30, Pittsburgh, PA 15240, USA; [email protected] Received 23 September 2014 Revised 27 January 2015 Accepted 22 February 2015
ABSTRACT Objectives Expedited partner therapy (EPT) effectively reduces rates of reinfection with chlamydia and increases the number of partners treated for the infection. Healthcare provider (HCP) provision of EPT is low. The objective of this qualitative study was to understand HCP views and opinions regarding the use of EPT in a state where EPT is permissible but underused. Methods Using a purposive sampling strategy to include diverse HCPs who treat young women at risk for chlamydia, 23 semistructured, in-depth interviews were conducted between October and December 2013. The interviews included questions about knowledge, attitudes, experiences with, and barriers and facilitators regarding the use of EPT. Results Many respondents report using EPT and believe the practice is beneficial for their patients. Most providers were unaware of their colleagues’ practices and had limited knowledge regarding institutional policies around EPT. HCPs noted a variety of barriers, such as fear of liability, confusion around the legal status of EPT and not being able to counsel patients’ partners that make routine use of this practice a challenge. Facilitators of EPT include speaking on the phone with patients’ partners and establishing legislation enabling EPT. Conclusions This is the first study to qualitatively examine HCPs’ perspectives on EPT in the USA. Barriers to EPT, including concerns about counselling patients’ partners and the legal status of EPT, can be overcome. EPT recommendations could include the use of phone calls as part of their guidelines. Changing EPT legislation at the state level in the USA is an important factor to facilitate EPT use.
INTRODUCTION
To cite: Rosenfeld EA, Marx J, Terry MA, et al. Sex Transm Infect Published Online First: [ please include Day Month Year] doi:10.1136/sextrans-2014051873
Chlamydia is a bacterial infection spread through sexual contact and is the most commonly reported infectious disease in the USA.1 Left untreated, chlamydia can cause pelvic inflammatory disease, ectopic pregnancy and infertility in women.2 Rates of reinfection are high, with 12–20% of women becoming reinfected with chlamydia within a year of their initial infection.3 Traditionally, healthcare providers (HCPs) encourage patients being treated for STIs to notify their sexual partners to seek treatment or may contact the patient’s sexual partners themselves.4 5 Research indicates that such approaches do not often result in treatment of partners.4 6 Even public health departments that have designated clinical staff to follow-up provide notification for 70% of family planning providers.16 A survey conducted in Arizona found that obstetricians/gynaecologists who received information about changes in state statutes about allowing EPT use were more likely to practise EPT.15 Participants spontaneously raised the issue of the potential harms of EPT, which has not been systematically reported in EPT trials to date. HCPs noted harms such as not being able to counsel patients’ partners, patients not giving their partners the medication and the possibility of intimate partner violence. While providers had positive perceptions of the benefits of EPT, they also have a number of concerns for the safety of their patients and their patients’ partners. Every form of partner notification has benefits and the potential for harm; a systematic review of randomised control trials on partner notification strategies, including EPT, found that the majority of trials do not report on or measure such harms.4 Further research on the potential magnitude of such harms should be considered, especially as EPT is disseminated in clinical practices. Several HCPs interviewed on their own determined that they preferred to speak to patients’ partners on the phone when providing EPT. HCPs sought ways to counsel patients’ partners about sexual behaviours, STIs and establish a provider–patient relationship; speaking to them on the phone was considered the most effective means to do so. Given that speaking on the phone to patients’ partners makes providers more comfortable using EPT, the CDC’s EPT recommendations could include the use of phone calls as part of their guidelines. In the UK, EPT is not permitted because patients must be medically assessed by providers before provision of medication.22 However, recently a form of EPT that complies with UK prescribing guidelines, accelerated partner therapy (APT), in which patients’ partners are either contacted via phone or receive consultation from a community pharmacist, has been assessed.22 Research has found that providers are willing to use APT and prefer the phone approach.23 Barriers and facilitators to using EPT centred around fears about being sued for adverse patient outcomes or being somehow liable for treating a patient they do not have a relationship with and the need to clarify the legality of EPT to 4
alleviate those fears. Our findings around barriers and facilitators to EPT were similar to the findings of studies conducted in the UK and Australia. A qualitative study conducted with general practitioners about their views on EPT and partner notification to treat chlamydia in Australia, a country that has no specific legislation about EPT, found that providers had concerns about treating a patient without evaluating their medical history and asserted that clarity around the legality of EPT would facilitate its use.24 A survey in the UK found that 22% of providers had used EPT, around one-third were opposed to the practice, providers felt that speaking on the phone with the partner was important, and the largest barrier to its use was the legality of EPT.25 This qualitative study demonstrates the way in which providers are willing to use EPT and have positive attitudes about the practice in a state where EPT is permissible but not expressly authorised. Barriers to EPT, including concerns about counselling patients’ partners and the legal status of EPT, can be overcome. Our study identified that providers have found ways to provide EPT in a manner they feel comfortable, by speaking to patients’ partner on the phone, enabling them to counsel patients’ partners. Providers desire clarity around the legal status of EPT; Pennsylvania could follow the lead of states such as California, New York and Arizona, and implement legislation that expressly allows EPT.20 Research is needed to examine how provider perspectives differ across states where EPT regulations differ. Further investigation should also quantify the frequency and impact of harms related to the provision of EPT. To make EPT more widely adopted, steps must be taken to ensure providers feel safe using this practice.
Key messages ▸ All participants felt that expedited partner therapy (EPT) would be a beneficial practice and something that would help reduce rates of reinfection with chlamydia for their patients. ▸ Participants noted barriers, including fear of liability and confusion around EPT’s legal status, and the harms of not being able to counsel patients’ partners. ▸ A facilitator of EPT involves speaking on the phone with patients’ partners; EPT recommendations could include the use of phone calls as part of their guidelines. ▸ Establishing specific legislation authorising EPT would facilitate its use.
Handling editor Jackie A Cassell Acknowledgements We would like to thank Carmel Shachar, JD MPH, staff attorney at Harvard Law School Center for Health Law and Policy Innovation, for her help in clarifying legal terms. Contributors ER conceived the study, designed the interview guide, conducted data collection for the whole study, wrote the analysis plan, analysed the data and drafted and revised the paper. JM designed the interview guide, monitored data collection, participated in interpretation of the results and revised the paper. MT designed the interview guide, participated in interpretation of the results and revised the paper. RS designed the interview guide and revised the paper. CP performed data analysis and participated in interpretation of the results. EM conceived the study, designed the interview guide, wrote the analysis plan, monitored data collection, participated in interpretation of the results and revised the paper. ER is the guarantor. Funding The Myrna Silverman Award and William Green Award from the University of Pittsburgh. Rosenfeld EA, et al. Sex Transm Infect 2015;0:1–5. doi:10.1136/sextrans-2014-051873
Downloaded from http://sti.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Health services research Competing interests None. Ethics approval The University of Pittsburgh Institutional Review Board.
12 13
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES 1 2
3
4
5 6
7
8
9
10
11
Centers for Disease Control Prevention. Sexually transmitted disease surveillance 2012. Atlanta: US Department of Health and Human Services, 2013. Walsh, Anderson LA, Irwin K. Observations from the CDC: the Silent Epidemic of Chlamydia trachomatis: the urgent need for detection and treatment in women. J Womens Health Gend Based Med 2000;9:339–43. Hosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis 2009;36:478–89. Ferreira A, Young T, Mathews C, et al. Strategies for partner notification for sexually transmitted infections, including HIV. Cochrane Database Syst Rev 2013;10: CD002843. Goldsworthy RC, Fortenberry DJ. Patterns and determinants of patient-delivered therapy uptake among healthcare consumers. Sex Transm Dis 2009;36:25–32. St. Lawrence JS, Montaño DE, Kasprzyk D, et al. STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians. Am J Public Health 2002;92:1784–8. Golden MR, Hogben M, Handsfield HH, et al. Partner notification for HIV and STD in the United States: low coverage for Gonorrhea, Chlamydial Infection, and HIV. Sex Transm Dis 2003;30:490–6. Centers for Disease Control and Prevention. Expedited partner therapy in the management of sexually transmitted diseases. Atlanta, GA: US Department of Health and Human Services, 2006. Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005;352:676–85. Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis 2003;30:49–56. Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis 2005;41:623–9.
Rosenfeld EA, et al. Sex Transm Infect 2015;0:1–5. doi:10.1136/sextrans-2014-051873
14
15
16
17 18
19 20 21 22
23
24
25
Trelle S, Shang A, Nartey L, et al. Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review. BMJ 2007;334:354. Althaus CL, Turner K, Mercer CH, et al. Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling. Health Technol Assess 2014;18:1–100. Centers for Disease Control and Prevention. Guidance on the Use of Expedited Partner Therapy in the Treatment of Gonorrhea. 2012. http://www.cdc.gov/std/ept/ GC-EPT-GuidanceNov-2012.pdf (accessed 25 Nov 2014). Taylor M, Collier M, Winscott M, et al. Reticence to prescribe: utilization of expedited partner therapy among obstetrics providers in Arizona. Int J STD AIDS 2011;22:449–52. Jotblad S, Park IU, Bauer HM, et al. Patient-delivered partner therapy for chlamydial infections: practices, attitudes, and knowledge of California family planning providers. Sex Transm Dis 2012;39:122–7. Hogben M, McCree DH, Golden MR. Patient-delivered partner therapy for sexually transmitted diseases as practiced by US physicians. Sex Transm Dis 2005;32:101–5. Packel LJ, Guerry S, Bauer HM, et al. Patient-delivered partner therapy for chlamydial infections: attitudes and practices of California physicians and nurse practitioners. Sex Transm Dis 2006;33:458–63. Niccolai LM, Winston DM. Physicians’ opinions on partner management for nonviral sexually transmitted infections. Am J Prev Med 2005;28:229–33. Centers for Disease Control and Prevention. Legal Status of Expedited Partner Therapy. http://www.cdc.gov/STD/ept/legal/default.htm (accessed 25 Nov 2014). Boyatzis RE. Transforming qualitative information: thematic analysis and code development. Sage, 1998. Estcourt C, Sutcliffe L, Cassell J, et al. Can we improve partner notification rates through expedited partner therapy in the UK? Findings from an exploratory trial of Accelerated Partner Therapy (APT). Sex Transm Infect 2012;88:21–6. Shackleton T, Sutcliffe L, Estcourt C. Is Accelerated Partner Therapy partner notification for sexually transmissible infections acceptable and feasible in general practice? Sex Health 2011;8:17–22. Pavlin NL, Parker RM, Piggin AK, et al. Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners. BMC Infect Dis 2010;10:274. Shivasankar S, Challenor R. Patient-delivered partner therapy in the UK: what do the professionals think? Int J STD AIDS 2008;19:437–40.
5
Downloaded from http://sti.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Healthcare providers' perspectives on expedited partner therapy for chlamydia: a qualitative study Elian A Rosenfeld, John Marx, Martha A Terry, Ron Stall, Chelsea Pallatino and Elizabeth Miller Sex Transm Infect published online March 19, 2015
Updated information and services can be found at: http://sti.bmj.com/content/early/2015/03/19/sextrans-2014-051873
These include:
References Email alerting service
This article cites 20 articles, 5 of which you can access for free at: http://sti.bmj.com/content/early/2015/03/19/sextrans-2014-051873 #BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
