Marta Wanat1, Sibyl Anthierens2, Christopher C Butler3, Louise Savic4, Sinisa Savic5, Sue H Pavitt6, Jonathan A T Sandoe7, Sarah Tonkin-Crine8. 1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom. Electronic address: marta.wanat@phc.ox.ac.uk. 2. Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium. 3. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom. 4. Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. 5. Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. 6. Dental Translational and Clinical Research Unit, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom. 7. Healthcare Associated Infection Group, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. 8. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.
Abstract
BACKGROUND: Removal of an inaccurate penicillin allergy record following testing allows patients to access first-line treatment for infections, and reduce the use of broad-spectrum antibiotics, which contribute to antibiotic resistance. However, it is seldom undertaken. OBJECTIVES: To identify clinicians' working in primary care and patients' views on barriers and enablers for penicillin allergy testing and subsequent antibiotic use. METHODS: Fifty interviews with patients and clinicians, including 31 patients with a record of penicillin allergy, 16 with experience of testing, and 19 clinicians. Interviews were analyzed thematically. RESULTS: Patients were often unaware of the benefits of penicillin allergy testing and only those patients who had experienced negative consequences of having a penicillin allergy label were motivated to get tested. Clinicians were reluctant to change patient records on the basis of their clinical judgment alone but had limited experience of referring patients with suspected penicillin allergy and were often uncertain about referral criteria and what the testing involved. Clinicians felt that allergy testing could be beneficial and patients who had attended testing reported benefits of the test. Clinicians expressed uncertainty related to whose responsibility it was to make sure that the patient understood allergy test results. CONCLUSIONS: Clinicians would benefit from information about penicillin allergy testing to be able to use these services appropriately, and to discuss referral with patients. Patients might be more motivated to seek testing if they were more informed regarding its benefits. Good communication between primary and secondary care would facilitate the updating of medical records, and promote better patient education.
BACKGROUND: Removal of an inaccurate penicillinallergy record following testing allows patients to access first-line treatment for infections, and reduce the use of broad-spectrum antibiotics, which contribute to antibiotic resistance. However, it is seldom undertaken. OBJECTIVES: To identify clinicians' working in primary care and patients' views on barriers and enablers for penicillinallergy testing and subsequent antibiotic use. METHODS: Fifty interviews with patients and clinicians, including 31 patients with a record of penicillinallergy, 16 with experience of testing, and 19 clinicians. Interviews were analyzed thematically. RESULTS:Patients were often unaware of the benefits of penicillinallergy testing and only those patients who had experienced negative consequences of having a penicillinallergy label were motivated to get tested. Clinicians were reluctant to change patient records on the basis of their clinical judgment alone but had limited experience of referring patients with suspected penicillinallergy and were often uncertain about referral criteria and what the testing involved. Clinicians felt that allergy testing could be beneficial and patients who had attended testing reported benefits of the test. Clinicians expressed uncertainty related to whose responsibility it was to make sure that the patient understood allergy test results. CONCLUSIONS: Clinicians would benefit from information about penicillinallergy testing to be able to use these services appropriately, and to discuss referral with patients. Patients might be more motivated to seek testing if they were more informed regarding its benefits. Good communication between primary and secondary care would facilitate the updating of medical records, and promote better patient education.
Authors: Marta Santillo; Marta Wanat; Mina Davoudianfar; Emily Bongard; Sinisa Savic; Louise Savic; Catherine Porter; Joanne Fielding; Christopher C Butler; Sue Pavitt; Jonathan Sandoe; Sarah Tonkin-Crine Journal: BMJ Open Date: 2020-10-01 Impact factor: 2.692