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How do you get treatment for partners of your patients who test positive for chlamydia? Meet "Joe Partner," San Francisco Health Plan’s approach to attacking the spread of the sexually transmitted disease (STD).
The recently enacted California Senate Bill 648, dubbed the "Ortiz Bill" after its sponsor, Sen. Deborah Ortiz of Sacramento, authorizes providers who diagnose chlamydia in a patient to prescribe or provide prescription antibiotic drugs to that patient’s sex partner or partners without prior examination. Taking advantage of this new legislation, San Francisco Health Plan, a not-for-profit health plan that provides affordable health coverage to lower-income San Franciscans, soon will begin paying for the treatment of partners of members with chlamydia in a bold step to reduce the number of recurring infections.
Chlamydia remains the most frequently reported infectious disease in the United States, according to the Atlanta-based Centers for Disease Control and Prevention (CDC).1 While almost 660,000 cases of chlamydia were reported in 1999, the CDC estimates that 3 million new cases of the STD occur in the United States each year.1 In women, untreated chlamydia may lead to pelvic inflammatory disease, one of the most common causes of ectopic pregnancy and infertility.
Karen Smith, MD, medical director for San Francisco Health Plan, estimates about 5% of the plan’s members in the high-risk 15-25 age group are infected with the disease, and that many of the plan members have silent (asymptomatic) infections. Even if patients do present with symptoms and receive treatment, they may return two months later with a similar infection, since their partners fail to receive treatment.
"We know that 40% of the time, the treated member comes back reinfected two months later," observes Smith.
Get partners treated
The Ortiz bill provides the necessary legal language for health care providers.
"What it does is give very exact language to physicians allowing them to write for that partner, sight unseen, if it is medically indicated," explains Smith. "Normally, that is considered potentially malpractice."
According to Smith, providers had been meeting the public health challenge of partner treatment by doubling the amount of medication and instructing the patient to split it with the partner or by writing a separate second prescription for the patient, dated a day or two later, which then could be given to the partner.
With the new language in hand, San Francisco Health Plan officials made the commitment to provide the chlamydia treatment prescriptions of patients’ partners at no charge. However, they faced two challenges. Women often are reluctant to identify their partners, so how could providers write the necessary prescriptions? Plus, how could they track the number of prescriptions for partners?
Enter Joe Partner’
San Francisco Health Plan is in the process of creating a second formulary that consists of just two drugs — doxycycline and azithromycin — for just one member, whose name is "Joe Partner." Now providers can write two prescriptions, one for the patient and one for the unseen partner. The new practice also will create two dispensing fees, which also will be covered by the health plan.
Final touches on the new program were being refined as of Contraceptive Technology Update’s press time, confirms Lucy Saldana, PharmD, a clinical pharmacist for San Francisco Health Plan. By being able to see the number of "Joe Partner" prescriptions, the plan will have a clearer picture of partner treatment, she predicts.
"We have added the option that doctors can write only one prescription, double the dose, and write partner Rx’ somewhere on the prescription, and the pharmacist will create two packaged prescriptions," reports Smith. "That is slightly less work than two prescriptions; either will achieve the same result."
Costs are offset
The health plan is a small one, consisting of some 31,000 members, says Saldana. In developing the partner treatment program, it looked at a number of variables, including the number of prescriptions written for doxycycline and azithromycin in 1999. Plan officials believe the costs of paying for the partner’s prescription and dispensing fee will be offset by the cost savings associated with reduced retreatment.
To raise provider awareness about chlamydia, San Francisco Health Plan recently held a series of programs for the 400 primary care physicians in its network. The presentations included information on chlamydia screening, CDC guidelines, and the HEDIS (Health Plan Employer Data and Information Set) 2000 chlamydia screening measure. The HEDIS screening measure, developed by the Washington, DC-based National Commit-tee for Quality Assurance, assesses the percentage of sexually active women aged 15-25 who are screened for the disease in managed care settings. (See CTU, February 2000, p. 17.)
Patient education sheets on chlamydia treatment also are being distributed to providers, reports Smith. Written in English and Spanish, the sheets include information on the infection, the drugs used, and potential side effects.
Education of pharmacists is key
One of the keys to the program’s success will be the pharmacy network education, says Saldana. There are approximately 3,000 pharmacies in San Francisco, so plan officials want to make sure pharmacists know how to properly process the partner prescriptions. Information will be faxed to every pharmacy with a detailed description of the partner treatment program and how to process the prescriptions.
"The key with this population is that you don’t want to make an extra call, do an extra fax, or have them wait extra time, because they get very suspicious in terms of What’s going on? Are you reporting me?’" says Saldana. "We understand that; so to encourage people to go for treatment and make them feel like there are no strings attached, we thought this approach was a really good process by which to get their needs met."
The health plan will perform monthly audits to track the program’s process and obtain feedback from those involved during regularly scheduled town hall meetings. By doing its homework in advance, health plan officials believe the introduction of "Joe Partner" will be well-received.
"What we want to do is threefold: Provide the treatment, make it safe, and make it easy on both the provider and the patients," says Smith.
1. Centers for Disease Control and Prevention. CDC Issues Major New Report on STD Epidemics. Atlanta; Dec. 5, 2000.