{"id":744,"date":"2012-11-09T13:27:53","date_gmt":"2012-11-09T13:27:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=744"},"modified":"2012-11-06T13:30:21","modified_gmt":"2012-11-06T13:30:21","slug":"expedited-partner-therapy-ept-why-in-the-us-and-not-in-the-uk-2","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2012\/11\/09\/expedited-partner-therapy-ept-why-in-the-us-and-not-in-the-uk-2\/","title":{"rendered":"Expedited Partner Therapy (EPT): Why in the US and not in the UK?"},"content":{"rendered":"<p>Expedited Partner Therapy (EPT) in sexual health is the practice of prescribing for the partner(s) of the patient without prior medical evaluation.\u00a0 In many countries (e.g. UK and Australia) the practice is not current, since it does not comply with prescribing guidance.\u00a0 But in the US it is being actively promoted by professional bodies (e.g. the American Association of Pediatrics (AAP)), and is currently employed in certain states, as a response to serious need which could not otherwise be met.<\/p>\n<p>A recent paper (Hsii, Golden et al.) (<a href=\"http:\/\/pediatrics.aappublications.org.libproxy.ucl.ac.uk\/search?fulltext=Neville+Golden&amp;submit=yes&amp;x=34&amp;y=9\">http:\/\/pediatrics.aappublications.org.libproxy.ucl.ac.uk\/search?fulltext=Neville+Golden&amp;submit=yes&amp;x=34&amp;y=9<\/a>) presents the results of a survey of junior doctors (residents) on pediatric training schemes in California (the first state to clarify the legality of EPT (2001)) regarding their knowledge of \u2013 and attitudes to \u2013 EPT. This is interesting for two reasons.\u00a0 Firstly, the light it sheds \u00a0on an EPT itself, as one among a number of alternatives to conventional treatment practice sometimes proposed as a more effective means to meet public health need.\u00a0\u00a0Second, on how the policy change required to implement the alternative approach tends to impact professional knowledge and behaviour over the longer term.<\/p>\n<p>Key findings of the paper are: 52% of trainees claim to have used EPT, though 30% felt uncomfortable doing so \u2013 and only 8% were \u201cfully aware\u201d of the legal status of EPT in California. \u00a0For those of us living in countries where EPT is unfamiliar, the surprise is that EPT should be current practice at all \u2013 especially in the context of adolescents with all the associated problems of child protection.\u00a0 The ill-ease of the trainees seems understandable given the complexity of issues surrounding EPT, which include, in addition to the question of its legal status and child protection issues, also problems around who pays for the prescription and how the partner\u2019s treatment is dealt with administratively (see AAP position paper: <a href=\"http:\/\/www.adolescenthealth.org\/AM\/Template.cfm?Section=Position_Papers&amp;Template=\/CM\/ContentDisplay.cfm&amp;ContentID=1473\">http:\/\/www.adolescenthealth.org\/AM\/Template.cfm?Section=Position_Papers&amp;Template=\/CM\/ContentDisplay.cfm&amp;ContentID=1473<\/a>).\u00a0 No doubt an objective of the paper, which is published in the journal of the AAP, is to encourage the further embedding of EPT in the everyday practice of young physicians.<\/p>\n<p>So why is the US heading off down this route faster than everyone else \u2013 and what are the chances that the rest of us \u2013 the UK, for instance \u2013 will one day find ourselves following in its wake?\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Golden and Estcourt usefully set out some of the diverse challenges facing\u00a0 implementation of EPT and related approaches the US and the UK (<a href=\"http:\/\/sti.bmj.com\/content\/87\/Suppl_2\/ii37.full\">http:\/\/sti.bmj.com\/content\/87\/Suppl_2\/ii37.full<\/a>); they also refer at some length, in the case of the UK, to a related alternative approach, Accelerated Partner Therapy (APT), pioneered in a recent exploratory trial in the UK, in which the medical evaluation of the partner takes place by telephone (see Roberts and Estcourt: <a href=\"http:\/\/sti.bmj.com\/content\/88\/1\/16.abstract\">http:\/\/sti.bmj.com\/content\/88\/1\/16.abstract<\/a>).<\/p>\n<p>The complexities around alternative referral approaches are considerable.\u00a0 Furthermore, it really is the treatment of the <em>adolescent<\/em> population that is envisaged by recent US initiatives (a population excluded from the recent UK exploratory trial on account of child protection issues).\u00a0 Child protection, of course, is no less a concern in the US (<a href=\"http:\/\/www.jahonline.org\/article\/S1054-139X(04)00200-9\/fulltext)\">http:\/\/www.jahonline.org\/article\/S1054-139X(04)00200-9\/fulltext)<\/a>.\u00a0 If such initiatives are hard to imagine in the UK, this may simply be because the problem of unmet need has nowhere attained the scale it has in the US, where it would justify over-riding the counter-balancing concerns. \u00a0Another source of difference between the US and the UK, not mentioned by Golden &amp; Estcourt, may be the absence of a professional interest group (like the paediatricians of the AAP) who feel themselves charged with lobbying specifically on behalf of the sexual health needs of adolescents (12+).\u00a0 Ultimately, though, it is probably the sheer scale of the US adolescent chlamydia epidemic \u2013 as yet unmatched in the UK \u2013 that has driven the recourse in the US to unorthodox solutions. \u00a0If and when alternative referral practices \u2013 APT, for instance \u2013 become more widespread in the UK, it may not be in the same contexts as in the US, or for the same purposes.\u00a0 At least we hope not.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Expedited Partner Therapy (EPT) in sexual health is the practice of prescribing for the partner(s) of the patient without prior medical evaluation.\u00a0 In many countries (e.g. UK and Australia) the practice is not current, since it does not comply with prescribing guidance.\u00a0 But in the US it is being actively promoted by professional bodies (e.g. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2012\/11\/09\/expedited-partner-therapy-ept-why-in-the-us-and-not-in-the-uk-2\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2786,1613,1647],"tags":[],"class_list":["post-744","post","type-post","status-publish","format-standard","hentry","category-expedited-partner-therapy","category-sexual-health-services","category-training-clinicians-in-sexually-transmited-diseases-man"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Expedited Partner Therapy (EPT): Why in the US and not in the UK? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2012\/11\/09\/expedited-partner-therapy-ept-why-in-the-us-and-not-in-the-uk-2\/\" \/>\n<meta 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