How Pharmacists Can Improve STD Treatment Adherence

Just one follow-up phone call can keep asymptomatic adolescents with sexually transmitted infections (STI) adherent to treatment.

A recent study evaluated whether Chlamydia trachomatis-positive adolescents actually pick up their prescriptions from pharmacies after receiving positive test results.

The issue of adherence is of particular concern for asymptomatic patients because they may not understand the importance of treatment in the absence of obvious signs of a health issue.

Among 1054 adolescents who presented to a pediatric emergency department for a concern other than an STI, 403 provided urine samples, 30 of which tested positive for C. trachomatis.

Twenty-eight of those C. trachomatis-positive patients were successfully contacted by phone and had a prescription called in to the pharmacy of their choice.

About a week later, the pharmacies were contacted to determine whether the patients had filled these prescriptions, which would indicate treatment adherence.

According to the pharmacies, 22 of the 28 patients originally contacted (74%) had obtained their prescription. Of the remaining 6 adolescents, 5 had not picked up their prescription at 1 week after the emergency department visit, and 1 refused treatment, planning to pursue a retest.

The investigators concluded that a follow-up phone call is an ideal way to encourage adolescents to fill their prescriptions for STI treatment, potentially because of the sensitive nature of their diagnosis.

They noted that future interventions should “focus on establishing structured follow-up for STI-positive patients, including locations for them to receive treatment.”

“Privacy is a huge issue for young people needing STD-related medications, [but] many retail pharmacies just don’t have private space for a discussion or don’t make it apparent that such space is available,” J. Dennis Fortenberry, MD, MS, chair of the American Sexual Health Association’s Board of Directors, told Pharmacy Times.

Beyond private space, Dr. Fortenberry said pharmacists should be wary of how critical confidentiality is for adolescents with STIs.

Previous research has shown that “surprisingly high” numbers of pharmacists discuss STI treatment with the patient’s parents without his or her permission, Dr. Fortenberry said. Some pharmacists might even refuse to fill a prescription for STI treatment without parental consent, he noted.

Other adherence counseling points that pharmacists should address with STI-infected adolescents include maintaining a medication schedule and the importance of taking all doses as prescribed.

“These might seem to be self-apparent to adults, but many adolescents have relatively little experience with the health care system, and obtaining treatment for an STD may be their first autonomous efforts at this kind of self-care,” Dr. Fortenberry noted.

The research letter titled “Treatment Compliance Among Asymptomatic Adolescents With Sexually Transmitted Infections” was published in JAMA Pediatrics on September 21, 2015.