Barriers and Facilitators of Expedited Partner Therapy in U.S. Emergency Departments: A Nationwide Qualitative Study

BackgroundExpedited partner therapy (EPT) is recommended for sex partners who might not seek care otherwise. Despite its high relevance in the management of sexually transmitted infections (STIs), EPT has had limited uptake in emergency departments (ED). We assessed barriers to and facilitators that could assist in increasing use of EPT in the EDs. MethodsWe conducted semi-structured interviews of 18 ED medical directors and key medical personnel from institutions that offer or were interested in offering EPT, as identified through our prior research. We developed and piloted an interview guide based on the Consolidated Framework for Implementation Research (CFIR). Interviews were recorded, transcribed, and analyzed using a thematic analysis. Themes were developed through iterative coding and team discussion. ResultsParticipant-reported barriers to implementing EPT included perceived legal liability, unclear clinical workflows, electronic health record (EHR) challenges when prescribing for a non-patient, ambiguity regarding duty to the partner, concerns about patient safety, and sexual health stigma. Facilitators included defined task-sharing, streamlined EHR processes, and leadership support. Participants emphasized the EDs potential to expand access to care for high-risk populations, provided that EPT implementation did not disrupt clinical operations. ConclusionsUnderstanding barriers and facilitators to EPT in EDs can inform the development of effective implementation strategies. While non-traditional prescribing processes pose challenges to routine adoption, experiences from EDs with established protocols suggest that these obstacles can be overcome.