Pharmacy-level barriers to implementing expedited partner therapy in Baltimore, Maryland

Jennifer Z. Qin, Clarissa P. Diniz, Jenell S. Coleman Fennell

Research output: Contribution to journalArticle

Abstract

Background: Addressing record high rates of Chlamydia trachomatis incidence in the United States requires the utilization of effective strategies, such as expedited partner therapy, to reduce reinfection and further transmission. Expedited partner therapy, which can be given as a prescription or medication, is a strategy to treat the sexual partners of index patients diagnosed with a sexually transmitted infection without prior medical evaluation of the partners. Objective: There are multiple steps in the prescription–expedited partner therapy cascade, and we sought to identify pharmacy-level barriers to implementing prescription–expedited partner therapy for Chlamydia trachomatis treatment. Study Design: We used spatial analysis and ArcGIS, a geographic information system, to map and assess geospatial access to pharmacies within Baltimore, MD, neighborhoods with the highest rates of Chlamydia trachomatis (1180.25–4255.31 per 100,000 persons). Expedited partner therapy knowledge and practices were collected via a telephone survey of pharmacists employed at retail pharmacies located in these same neighborhoods. Cost of antibiotic medication in US dollars was collected. Results: Census tracts with the highest Chlamydia trachomatis incidence rates had lower median pharmacy density than other census tracts (26.9 per 100,000 vs 31.4 per 100,000, P <.001). We identified 25 pharmacy deserts. Areas defined as pharmacy deserts had larger proportions of black and Hispanic or Latino populations compared with non-Hispanic whites (93.1% vs 6.3%, P <.001) and trended toward higher median Chlamydia trachomatis incidence rates (1170.0 per 100,000 vs 1094.5 per 100,000, P =.110) than non–pharmacy desert areas. Of the 52 pharmacies identified, 96% (50 of 52) responded to our survey. Less than a fifth of pharmacists (18%, 9 of 50) were aware of expedited partner therapy for Chlamydia trachomatis. Most pharmacists (59%, 27 of 46) confirmed they would fill an expedited partner therapy prescription. The cost of a single dose of azithromycin (1 g) ranged from 5.00 to 39.99 US dollars (median, 30 US dollars). Conclusion: Limited geographic access to pharmacies, lack of pharmacist awareness of expedited partner therapy, and wide variation in expedited partner therapy medication cost are potential barriers to implementing prescription–expedited partner therapy. Although most Baltimore pharmacists were unaware of expedited partner therapy, they were generally receptive to learning about and filling expedited partner therapy prescriptions. This finding suggests the need for wide dissemination of educational material targeted to pharmacists. In areas with limited geographic access to pharmacies, expedited partner therapy strategies that do not depend on partners physically accessing a pharmacy merit consideration.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Baltimore
Chlamydia trachomatis
Pharmacists
Pharmacies
Therapeutics
Prescriptions
Censuses
Hispanic Americans
Costs and Cost Analysis
Incidence
Geographic Information Systems
Azithromycin
Spatial Analysis
Sexual Partners
Sexually Transmitted Diseases
Telephone

Keywords

  • Baltimore
  • Chlamydia
  • expedited partner therapy
  • partner therapy
  • pharmacy access
  • pharmacy desert
  • sexually transmitted disease
  • sexually transmitted infection

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Pharmacy-level barriers to implementing expedited partner therapy in Baltimore, Maryland. / Qin, Jennifer Z.; Diniz, Clarissa P.; Coleman Fennell, Jenell S.

In: American Journal of Obstetrics and Gynecology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Addressing record high rates of Chlamydia trachomatis incidence in the United States requires the utilization of effective strategies, such as expedited partner therapy, to reduce reinfection and further transmission. Expedited partner therapy, which can be given as a prescription or medication, is a strategy to treat the sexual partners of index patients diagnosed with a sexually transmitted infection without prior medical evaluation of the partners. Objective: There are multiple steps in the prescription–expedited partner therapy cascade, and we sought to identify pharmacy-level barriers to implementing prescription–expedited partner therapy for Chlamydia trachomatis treatment. Study Design: We used spatial analysis and ArcGIS, a geographic information system, to map and assess geospatial access to pharmacies within Baltimore, MD, neighborhoods with the highest rates of Chlamydia trachomatis (1180.25–4255.31 per 100,000 persons). Expedited partner therapy knowledge and practices were collected via a telephone survey of pharmacists employed at retail pharmacies located in these same neighborhoods. Cost of antibiotic medication in US dollars was collected. Results: Census tracts with the highest Chlamydia trachomatis incidence rates had lower median pharmacy density than other census tracts (26.9 per 100,000 vs 31.4 per 100,000, P <.001). We identified 25 pharmacy deserts. Areas defined as pharmacy deserts had larger proportions of black and Hispanic or Latino populations compared with non-Hispanic whites (93.1{\%} vs 6.3{\%}, P <.001) and trended toward higher median Chlamydia trachomatis incidence rates (1170.0 per 100,000 vs 1094.5 per 100,000, P =.110) than non–pharmacy desert areas. Of the 52 pharmacies identified, 96{\%} (50 of 52) responded to our survey. Less than a fifth of pharmacists (18{\%}, 9 of 50) were aware of expedited partner therapy for Chlamydia trachomatis. Most pharmacists (59{\%}, 27 of 46) confirmed they would fill an expedited partner therapy prescription. The cost of a single dose of azithromycin (1 g) ranged from 5.00 to 39.99 US dollars (median, 30 US dollars). Conclusion: Limited geographic access to pharmacies, lack of pharmacist awareness of expedited partner therapy, and wide variation in expedited partner therapy medication cost are potential barriers to implementing prescription–expedited partner therapy. Although most Baltimore pharmacists were unaware of expedited partner therapy, they were generally receptive to learning about and filling expedited partner therapy prescriptions. This finding suggests the need for wide dissemination of educational material targeted to pharmacists. In areas with limited geographic access to pharmacies, expedited partner therapy strategies that do not depend on partners physically accessing a pharmacy merit consideration.",
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