AMA Report (6) Expedited Partner Therapy

What the heck is “expedited partner therapy”?

Do you have any idea what “expedited partner therapy” is all about? It sounds like a kind of cut and dried, straightforward administrative action. But it isn’t!! It is all about the treatment and prevention of sexually transmitted diseases through the use of identified patients with the disease to personally go to their single or various partners and presumably inform them about the patient’s diagnosed condition, to educate them about the necessity to be seen in a medical clinic for medical evaluation and treatment as necessary. However, if the partners are unwilling to go, the patient is to educate them about the nature of the disease, the treatment and the risks involved in taking the treatment. Then, the patient will have been provided with the medication to give to the partner to take. Under this “expedited” medical care, partners of the infected patient will be treated, completely without a professional medical diagnosis based on history, physical and laboratory tests, without direct education by the physician and provided with a medication, as either as prophylaxis or treatment, without a diagnosis and without any formal professional supervision. I have included the conclusion and recommendations of the report below but I would suggest that the visitor go to the link below and read the entire report including further description of the “expedited partner therapy”, the history and rationale and the ethical and legal issues involved.

The subject Report 6 Expedited Partner Therapy is one of a series of 8 Reports of the Council of Ethical and Judicial Affairs (CEJA) of the American Medical Association. These reports have not yet been adopted as AMA policy; they will be discussed and debated in June 2008. If they receive the support of the majority of the delegates from the state and specialty societies, they will become policy. Anyone, including the general public, can provide testimony on CEJA reports either in person at the meeting or by writing to ceja@ama-assn.org.

I am presenting each Report as a separate thread on this blog. By clicking on the link above, you can gain access to the specific wording of the Reports, 1 through 6 are to be Amendments to the Constitution and Bylaws of the American Medical Association. Reports 7 and 8 are for Informational purposes. Why should the public be interested in these reports? They are part of the ethics of the system of medicine in the United States and may be reflected elsewhere in the world. Through the practice of medicine by all physicians, the rules presented in these reports can be applied to and may affect all patients. You may write directly your comments to CEJA at the e-mail address above and, of course, you are certainly welcome to post your comments on this particular Report here.

CONCLUSION

Expedited partner therapy has been demonstrated to be a clinically effective strategy for the treatment and limitation of spread of a limited number of sexually transmitted infections. As such, physicians should recognize the practice as a valid tool for promoting public health when appropriately indicated. However, EPT in the absence of a traditional patient-physician relationship creates distinct ethical concerns pertaining to informed consent, confidentiality, and patient safety. Physicians should therefore emphasize to patients that medical care within a patient-physician relationship is preferred. Only in circumstances when this is impossible or unlikely should EPT be considered. While it may be ethical to use EPT to minimize the negative health consequences of sexually-transmitted diseases, physicians should make reasonable efforts to refer the partners of their patients to appropriate health care professionals.

RECOMMENDATION

The Council on Ethical and Judicial Affairs recommends that the following be adopted and the remainder of the report be filed:

Expedited Partner Therapy (EPT) is the practice of treating the sex partners of patients with sexually transmitted diseases via patient-delivered partner therapy without the partner receiving a medical evaluation or professional prevention counseling. While this practice is presently recommended by the Centers for Disease Control and Prevention for use in very limited circumstances (for gonorrhea or chlamydial infection in heterosexual men and women), EPT may be recommended for additional applications in the future.

Although EPT has been demonstrated to be effective at reducing the burden of certain diseases, it also has ethical implications. EPT potentially abrogates the standard informed consent process, compromises continuity of care for patients’ partners, encroaches upon the privacy of patients and their partners, increases the possibility of harm by a medical or allergic reaction, leaves other diseases or complications undiagnosed, and may violate state practice laws. The following guidelines are offered for use in establishing whether EPT is appropriate:

(1) Physicians should determine the need for EPT by engaging in open discussions with patients to ascertain their partners’ abilities to access medical services. Only if the physician reasonably believes that a patient’s partner(s) will be unwilling or unable to seek treatment within the context of a traditional patient-physician relationship should the use of EPT be considered.

(2) Prior to initiating EPT, physicians are advised to seek the guidance of public health officials, as well as determine the legal status of EPT in their state.

(3) If the physician chooses to initiate EPT, he or she must provide patients with appropriate instructions regarding EPT and its accompanying medications and answers to any questions that they may have.

(4) Physicians must provide patients with educational material to share with their partners that encourages the partners to consult a physician as a preferred alternative to EPT, and that discloses the risk of potential adverse drug reactions and the possibility of dangerous interactions between the patient-delivered therapy and other medications that the partner may be taking. The partner should also be informed that he or she may be affected by other STDs that may be left untreated by the delivered medicine.

(5) The treating physician should also make reasonable efforts to refer a patient’s partner(s) to appropriate health care professionals.

What do you think about expedited partner therapy and especially if it is approved for application beyond the current limited diagnoses of gonorrhea or chlamydial infection in heterosexual men and women? Write us about your opinion on this interesting twist of medical care and prevention. ..Maurice.