In the JournalsPerspective

Antibiotic prescriptions for teens with STIs are infrequently filled

Monika Goyal, MD, MSCE
Monika Goyal

Less than 60% of prescriptions for the treatment of cervicitis/urethritis and pelvic inflammatory disease among teens were filled during a 2-year study period conducted at two urban pediatric EDs, according to a research letter published today in JAMA Pediatrics. The researchers found that hospital admission was the only factor associated with prescription filling.

According to the CDC, Americans aged 15 to 24 make up 27% of the sexually active population but account for 50% of the 20 million new STI cases reported in the United States each year.

“Rates of STIs are at an all-time high, and adolescents are disproportionately affected,” Monika Goyal, MD, MSCE, assistant chief of the children’s division of emergency medicine and trauma services at Children’s National Health System, and the letter’s senior author, told Infectious Disease News. “Emergency clinicians are uniquely positioned to help address these worrisome trends, since the emergency department is a key setting for diagnosing and treating STIs.”

The research builds on the team’s prior work at one urban children’s hospital ED, where less than half of all teens diagnosed with STIs filled prescriptions for outpatient antibiotics upon discharge. For the expanded research, Goyal and colleagues conducted a retrospective cohort study of patients aged 13 to 19 years who were admitted to two pediatric EDs affiliated with Children’s National Medical Center in Washington, D.C.

A total of 696 ED visits by patients with diagnosed STIs were made during the study period, according to the letter. Among them, 208 patients received outpatient antimicrobial prescriptions for cervicitis/urethritis (n = 65) or pelvic inflammatory disease (n = 143). According to Goyal and colleagues, 57.7% (95% CI, 50.9-64.5) of total prescriptions were filled. Multivariable analysis revealed hospital admission as the only factor associated with prescription filling (73.7% vs. 54.1%; adjusted OR = 2.3), the authors reported.

“We need to better understand specific barriers to adolescents filling prescriptions, which can then inform novel interventions to improve treatment compliance, such as providing medication during the emergency department visit and developing sexual and reproductive health follow-up clinics located within the emergency department,” Goyal said. “These ED-based clinics could facilitate in-depth conversations with clinicians, which may help patients to embrace antimicrobial therapy as a way to improve their health in the near term and long term.”

With widespread use of cell phones among teens, Goyal also suggested the use of text messages as a possible way to send reminders that are compliant with the Health Insurance Portability and Accountability Act to improve treatment adherence. – by Joe Gramigna

Reference:

CDC. Youth STI infographic. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/Youth-STI-Infographic.pdf. Accessed May 24, 2019.

Disclosures: The authors report no relevant financial disclosures.

Monika Goyal, MD, MSCE
Monika Goyal

Less than 60% of prescriptions for the treatment of cervicitis/urethritis and pelvic inflammatory disease among teens were filled during a 2-year study period conducted at two urban pediatric EDs, according to a research letter published today in JAMA Pediatrics. The researchers found that hospital admission was the only factor associated with prescription filling.

According to the CDC, Americans aged 15 to 24 make up 27% of the sexually active population but account for 50% of the 20 million new STI cases reported in the United States each year.

“Rates of STIs are at an all-time high, and adolescents are disproportionately affected,” Monika Goyal, MD, MSCE, assistant chief of the children’s division of emergency medicine and trauma services at Children’s National Health System, and the letter’s senior author, told Infectious Disease News. “Emergency clinicians are uniquely positioned to help address these worrisome trends, since the emergency department is a key setting for diagnosing and treating STIs.”

The research builds on the team’s prior work at one urban children’s hospital ED, where less than half of all teens diagnosed with STIs filled prescriptions for outpatient antibiotics upon discharge. For the expanded research, Goyal and colleagues conducted a retrospective cohort study of patients aged 13 to 19 years who were admitted to two pediatric EDs affiliated with Children’s National Medical Center in Washington, D.C.

A total of 696 ED visits by patients with diagnosed STIs were made during the study period, according to the letter. Among them, 208 patients received outpatient antimicrobial prescriptions for cervicitis/urethritis (n = 65) or pelvic inflammatory disease (n = 143). According to Goyal and colleagues, 57.7% (95% CI, 50.9-64.5) of total prescriptions were filled. Multivariable analysis revealed hospital admission as the only factor associated with prescription filling (73.7% vs. 54.1%; adjusted OR = 2.3), the authors reported.

“We need to better understand specific barriers to adolescents filling prescriptions, which can then inform novel interventions to improve treatment compliance, such as providing medication during the emergency department visit and developing sexual and reproductive health follow-up clinics located within the emergency department,” Goyal said. “These ED-based clinics could facilitate in-depth conversations with clinicians, which may help patients to embrace antimicrobial therapy as a way to improve their health in the near term and long term.”

With widespread use of cell phones among teens, Goyal also suggested the use of text messages as a possible way to send reminders that are compliant with the Health Insurance Portability and Accountability Act to improve treatment adherence. – by Joe Gramigna

Reference:

CDC. Youth STI infographic. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/Youth-STI-Infographic.pdf. Accessed May 24, 2019.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Carlos del Rio

    Carlos del Rio

    The take-home message of this study is that just because you wrote a prescription does not mean the patient will fill it. I do not think this is too surprising, in particular among adolescents with an STD, who may not have the money to pay for a copay. The best way to ensure treatment for an STD is to treat right there and then, be it at the clinic or the ED.

    • Carlos del Rio, MD
    • Professor of medicine
      Emory University School of Medicine

    Disclosures: Del Rio reports no relevant financial disclosures.