Neighborhood Social Vulnerability and Access to Expedited Partner Therapy Prescriptions: A Secret Shopper Audit Survey.

BACKGROUND

Sexually transmitted infections (STIs) disproportionately affect socially vulnerable populations. Expedited partner therapy (EPT) reduces reinfection rates by treating partners without requiring a medical visit yet remains underutilized in the electronic prescription era. Studies show low pharmacist awareness of EPT, with limited research on its real-world availability in pharmacies or variability by Social Vulnerability Index (SVI) factors. This study assessed pharmacist awareness and willingness to fill hypothetical nameless electronic EPT prescriptions in New York City pharmacies and examined variations by SVI.

METHODS

A cross-sectional audit survey of 335 New York City pharmacies used a telephone-based secret shopper approach. Pharmacist awareness of EPT, willingness to fill, and insurance acceptance were evaluated. Multivariable logistic regression examined associations with SVI, adjusting for pharmacy type, location, and local chlamydia rates.

RESULTS

Of surveyed pharmacies, 40% were aware of EPT, with significantly lower awareness in nonchain pharmacies than national chains (34% vs. 54%, P = 0.02). Only 28% of pharmacists stated they would be willing to fill nameless prescriptions. Most prescriptions (34%) would be filled under the index patient's name, and 86% would accept insurance. Common reasons for refusal included unfamiliarity with EPT (62%) and misconceptions about legal name requirements (28%). Awareness was higher in pharmacies located in the highest SVI quartile (odds ratio, 3.7; 95% confidence interval, 1.3-10.8), but willingness to fill did not vary by SVI ( P = 0.35).

CONCLUSIONS

Despite greater EPT awareness in socioeconomically vulnerable areas, pharmacist willingness to fill nameless EPT prescriptions remains limited across areas. Efforts to educate pharmacists and standardize e-prescribing processes are needed to expand EPT access and reduce STI disparities.