Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom.
Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.
J Allergy Clin Immunol Pract. 2019 Jul-Aug;7(6):1888-1893.e1. doi: 10.1016/j.jaip.2019.02.036. Epub 2019 Mar 12.
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.
To identify clinicians' working in primary care and patients' views on barriers and enablers for penicillin allergy testing and subsequent antibiotic use.
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.
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.
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.
通过检测消除不准确的青霉素过敏记录，使患者能够获得感染的一线治疗，并减少广谱抗生素的使用，从而有助于减少抗生素耐药性。然而，这种做法很少被采用。
确定在初级保健中工作的临床医生和患者对青霉素过敏检测及随后抗生素使用的障碍和促进因素的看法。
对 50 名患者和临床医生进行了访谈，其中包括 31 名有青霉素过敏记录的患者、16 名有检测经验的患者和 19 名临床医生。访谈内容采用主题分析法进行分析。
患者通常不知道青霉素过敏检测的好处，只有那些经历过青霉素过敏标签负面影响的患者才有动力接受检测。临床医生不愿意仅仅根据自己的临床判断来改变患者的记录，但他们对转诊有青霉素过敏疑似患者的经验有限，并且经常对转诊标准和检测涉及的内容感到不确定。临床医生认为过敏检测可能是有益的，那些接受过检测的患者报告了检测的好处。临床医生对谁有责任确保患者了解过敏检测结果表示不确定。
临床医生需要了解有关青霉素过敏检测的信息，以便能够适当地使用这些服务，并与患者讨论转诊问题。如果患者更了解检测的好处，他们可能会更有动力寻求检测。初级保健和二级保健之间的良好沟通将有助于更新医疗记录，并促进更好的患者教育。
