Impact of an Electronic Medical Record Best Practice Alert on Expedited Partner Therapy for Chlamydia Infection and Reinfection

Sarah J Willis; Heather Elder; Noelle M Cocoros; Myfanwy Callahan; Katherine K Hsu; Michael Klompas

doi:10.1093/ofid/ofab574

Impact of an Electronic Medical Record Best Practice Alert on Expedited Partner Therapy for Chlamydia Infection and Reinfection

Open Forum Infect Dis. 2021 Nov 16;9(1):ofab574. doi: 10.1093/ofid/ofab574. eCollection 2022 Jan.

Authors

Sarah J Willis^{1

2}, Heather Elder², Noelle M Cocoros¹, Myfanwy Callahan³, Katherine K Hsu², Michael Klompas^{1

4}

Affiliations

¹ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
² Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts, USA.
³ Atrius Health, Boston, Massachusetts, USA.
⁴ Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Abstract

Background: Atrius Health implemented a best practice alert (BPA) to encourage clinicians to provide expedited partner therapy (EPT) in October 2014. We assessed (1) the impact of the BPA on EPT provision and chlamydial reinfection and (2) the impact of EPT on testing for chlamydia reinfection and reinfection rates.

Methods: We included patients ≥15 years with ≥1 positive chlamydia test between January 2013 and March 2019. Tests-of-reinfection were defined as chlamydia tests 28-120 days after initial infection, and corresponding positive results were considered evidence of reinfection. We used interrupted time series analyses to identify changes in (1) frequency of EPT, (2) tests-of-reinfection, and (3) reinfections after the BPA was released. Log-binomial regression models, with generalized estimating equation methods, assessed associations between (1) EPT and tests-of-reinfection and (2) EPT and reinfection.

Results: Among 7267 chlamydia infections, EPT was given to 1475 (20%) patients. Expedited partner therapy frequency increased from 15% to 22% of infections between January 2013 and September 2014 (β = 0.003, P = .03). After the BPA was released, EPT frequency declined to 19% of infections by March 2019 (β = -0.004, P = .008). On average, 35% of chlamydia infections received a test-of-reinfection and 7% were reinfected; there were no significant changes in these percentages after BPA implementation. Patients given EPT were more likely to receive tests-of-reinfection (prevalence ratio [PR] 1.09; 95% confidence interval [CI], 1.01-1.16) but without change in reinfections (PR 0.88; 95% CI, 0.66-1.17).

Conclusions: Best practice alerts in electronic medical record systems may not be effective at increasing EPT prescribing and decreasing chlamydial reinfection. However, patients given EPT were more likely to receive a test of chlamydia reinfection.

Keywords: antibacterial agents; chlamydia; electronic health records; expedited partner therapy.