ISDH Releases Guidelines For Expedited Partner Therapy
In 2010 the IAFP All-Member Congress of Delegates passed a resolution asking the IAFP to support regulation or legislation to allow the practice of expedited partner therapy (EPT) in Indiana. With the IAFP’s support in late 2011 the Indiana Medical Licensing Board finalized regulations legalizing the use of expedited partner therapy by physicians in Indiana and in April 2012 the Indiana State Department of Health (ISDH) released physician guidelines for EPT.
Expedited partner therapy (EPT) is the practice of prescribing or dispensing antibiotics to the sexual partner(s) of a physician diagnosed patient without an exam of the sexual partner(s). Since 2006 the Centers for Disease Control has recommended EPT as an option for preventing sexually transmitted disease reinfection for certain infections.
Prior to the Medical Licensing Board rule EPT was considered illegal in Indiana because regulation forbid the prescribing of medication to patients without first being seen (except in on call and specific other settings). With the new law physicians can use EPT for the partners of patients with chlamydia and gonorrhea, but are not required to. ISDH still recommends that physicians try to motivate patients to refer their partners for clinical care where full evaluation, testing, and treatment can take place.
The new ISDH advisory documents for physicians include guidance on documentation, information on appropriate antibiotics, chart inserts, and patient documents. Physicians who wish to prescribe through EPT should review and use the health department’s guidelines.
The Indiana State Department of Health’s STD program page:
Direct link to ISDH Guidelines
Guidance for Health Care Professionals in Indiana
Direct link to ISDH FAQs about Expedited Partner Therapy
Frequently Asked Questions
For physicians who wish to read the final Medical Licensing Board rule:
844 IAC 5-4-1
IC 25-22.5-2-7 IC 25-1-9; IC 25-22.5-1-2; IC 25-23-1-19.4
Sec. 1. (a) Except in institutional settings, on-call situations, cross-coverage situations, and situations involving advanced practice nurses with prescriptive authority practicing in accordance with standard care arrangements, as described in subsection (d), a physician shall not prescribe, dispense, or otherwise provide, or cause to be provided, any controlled substance to a person who the physician has never personally physically examined and diagnosed.
(b) Except in institutional settings, on-call situations, cross-coverage situations, and situations involving advanced practice nurses with prescriptive authority practicing in accordance with the requirements of IC 25-23-1-19.4 and 848 IAC 5, as described in subsection (d), a physician shall not prescribe, dispense, or otherwise provide, or cause to be provided, any legend drug that is not a controlled substance to a person who the physician has never personally physically examined and diagnosed unless the physician is providing care in consultation with another physician who has an ongoing professional relationship with the patient, and who has agreed to supervise the patient's use of the drug or drugs to be provided.
(c) A physician shall not advertise or offer, or permit the physician's name or certificate to be used in an advertisement or offer, to provide any legend drug in a manner that would violate subsection (a) or (b).
(d) Subsections (a) and (b) do not apply to or prohibit the following: (1) The provision of drugs to a person who is admitted as an inpatient to or is a resident of an institutional facility. (2) The provision of controlled substances or legend drugs by a physician to a person who is a patient of a colleague of the physician, if the drugs are provided pursuant to an on-call or cross-coverage arrangement between the physicians. (3) The provision of controlled substances or legend drugs by emergency medical squad personnel, nurses, or other appropriately trained and licensed individuals as permitted by IC 25-22.5-1-2. (4) The provision of controlled substances or drugs by an advanced practice nurse with prescriptive authority practicing in accordance with a standard care arrangement that meets the requirements of IC 25-23-1-19.4 and 848 IAC 5.
(Medical Licensing Board of Indiana; 844 IAC 5-4-1; filed Oct 1, 2003, 9:32 a.m.: 27 IR 524; errata filed Oct 8, 2003, 1:45 p.m.: 27 IR 538; readopted filed Dec 1, 2009, 9:13 a.m.: 20091223-IR-844090779RFA; readopted filed Jun 16, 2010, 12:14 p.m.: 20100630-IR-844090779RFA)
844 IAC 5-4-2
Expedited partner therapy
IC 25-22.5-2-7 IC 25-1-9
STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE
Sec. 2. Section 1 of this rule does not apply if the physician is prescribing or dispensing medications for the treatment of Chlamydia trachomatis or Neisseria gonorrhoeae to sex partner(s) of the physician's diagnosed patient without requiring examination of the sex partner(s). Medications must be in accordance with current professional theory or practice for the treatment of these infections. The current Centers for Disease Control and Prevention of Sexually Transmitted Diseases Treatment Guidelines shall be considered an authoritative source of such current professional theory or practice. Partner management of patients with gonorrhea or chlamydia shall include providing the following items:
(1) Notification to the infected patient that all partners should be evaluated and treated; (2) Written materials for the infected patient to give partners that state that a clinical evaluation is desirable; lists common medication side effects and the appropriate response to them; fact sheets regarding sexually transmitted diseases; and emergency contact information; (3) Prescriptions or dispensed medications and accompanying written materials shall be given to the physician's patient for distribution to named partners; and (4) The physician shall maintain appropriate documentation of partner management. Documentation shall include the names of partners, if available, and a record of treatment provided. If the partner's name is not available, documentation shall be kept within patient's file.
(Medical Licensing Board of Indiana; 844 IAC 5-4-2; filed Sep 28, 2011, 11:06 a.m.: 20111026-IR-844110044FRA)