Abstract
Background
The 2021 CDC STI treatment guidelines recommend a 7-day course of metronidazole or single-dose tinidazole for women with trichomoniasis due to improved patient outcomes compared to single-dose metronidazole therapy. The purpose of this study was to determine the impact of an electronic health record (EHR) alert on optimal trichomoniasis prescribing in women.
Methods
This was an IRB-approved, single pre-test, post-test quasi-experiment of women >15 years positive for Trichomonas vaginalis who were treated in emergency department (ED) or outpatient clinic settings from 10/2023-12/2023 (pre-alert group) and 10/2024 to 12/2024 (post-alert group). An EHR alert was implemented 9/2024 that notifies prescribers that metronidazole 2g single-dose is not a recommended regimen and suggests CDC-recommended treatments (Figure 1). The primary outcome was the proportion of women who received a single dose of metronidazole 2g. Secondary outcomes were assessed in a cohort of patients from all care settings and included the number of clinical support alerts in the post-group and the proportion of women prescribed single-dose metronidazole after an alert.
Results
285 patients were included: 49.8% pre- and 50.2% post-intervention. The median (IQR) patient age was 32 (IQR 23-41) years, 204 were black (71.6%), 65 were co-infected with bacterial vaginosis (22.8%), and 198 were symptomatic (69.5%). 8.5% of patients received single-dose metronidazole in the pre-alert group compared to 2.8% of patients in the post-alert group (unAdjOR, 0.312; 95%CI: 0.098-0.991). The clinical support alert fired 121 times across all care settings during the 3-month post-implementation period. 41% of these alerts were in ambulatory care settings; 50% in emergency department settings and 9% in inpatient labor and delivery units. There were 100 distinct patient orders that met inclusion criteria; 60 (50%) alerts were immediately accepted, and recommended therapy was chosen. Single-dose metronidazole treatment was ordered in 24 (20%) patients despite the alert.
Conclusion
The implementation of a trichomoniasis clinical support tool was associated with a decrease in the prescription of single dose metronidazole for women treated for trichomoniasis.
Disclosures
Jacob Manteuffel, MD, Cepheid: Honoraria|Gilead Sciences: Grant/Research Support|Indivior: Advisor/Consultant