The Impact of an Educational Intervention on Emergency Department Advanced Practice Providers’ Sexually Transmitted Infection Treatment Guideline Adherence

Abstract

Despite continually evolving guidelines for the treatment of sexually transmitted infections (STI), chlamydia, gonorrhea, and syphilis remain the most common reportable bacterial infections within the United States. This project evaluated the effectiveness of a sexually transmitted infection treatment guideline (STITG) education presentation for advanced practice providers (nurse practitioners and physician assistants) in two urban emergency departments (EDs) in southern Arizona. The educational presentation reviewed the documentation of adherence of three areas of the 2021 Centers for Disease Control and Prevention (CDC) STITG: Pharmaceutical management and testing, documentation of the 5 Ps (number of sexual partners, sexual practices/physical site of exposure, use of barrier protection, past STIs and pregnancy plans) and community follow-up. The STITG education presentation effectiveness was measured using a retrospective and prospective chart review evaluating the advanced practice providers (APP) treatment adherence to 2021 CDC guidelines for individuals seeking care for STI exposure/symptoms. This project included a chart review of individuals 18-years of age or older seeking care in the ED between March 1, 2022, and August 31, 2022. Eligible charts were identified by specific ICD 10 codes and sorted according to providers. Patients managed by the APPs who attended the STITG educational intervention were included for review. Those managed by attending or resident physicians were excluded. Seventy-nine charts were reviewed based on the above inclusion criteria during the six-month project period. Patient-specific demographics were reviewed, the post-intervention review more individuals indicated having a primary care provider (PCP) versus the pre-intervention review, 15% versus 2.6%. Medication treatment adherence between pre-and post-intervention phases had no statistical change, with most inappropriate medication management due to patient refusal of treatment. Testing for syphilis/HIV during post-intervention compared to pre-intervention decreased 35% versus 66.7%. The overall documentation of the 5 Ps remained the same during the project. The PCP remained the number one location documented for follow-up even as most charts did not have an identified PCP. This project highlights that an educational intervention alone does not improve treatment guideline adherence and that further investigation to identify other interventions to support providers’ adherence to the 2021 CDC STI treatment guideline.