基层医疗中青霉素过敏管理：一项针对患者和基层医疗医生的定性研究。
Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians.
机构信息
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK.
Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
出版信息
BMC Fam Pract. 2021 Jun 11;22(1):112. doi: 10.1186/s12875-021-01465-1.
BACKGROUND
Six percent of patients are allergic to penicillin according to their medical records. While this designation protects a small number of truly allergic patients from serious reactions, those who are incorrectly labelled may be denied access to recommended first line treatment for many infections. Removal of incorrect penicillin allergy may have positive health consequences for the individual and the general population. We aimed to explore primary care physicians' (PCPs) and patients' views and understanding of penicillin allergy with a focus on clinical management of infections in the face of a penicillin allergy record.
METHODS
We conducted an interview study with 31 patients with a penicillin allergy record, and 19 PCPs in the North of England. Data were analysed thematically.
RESULTS
Patients made sense of their allergy status by considering the timing and severity of symptoms. Diagnosis of penicillin allergy was reported to be 'imperfect' with PCPs relying on patient reports and incomplete medical records. PCPs and patients often suspected that an allergy record was incorrect, but PCPs were reluctant to change records. PCPs had limited knowledge of allergy services. PCPs often prescribed alternative antibiotics which were easy to identify. Both patients and PCPs differed in the extent to which they were aware of the negative consequences of incorrect penicillin allergy records, their relevance and importance to their lives, and management of penicillin allergy.
CONCLUSIONS
PCPs and patients appear insufficiently aware of potential harms associated with incorrect penicillin allergy records. Some of the problems experienced by PCPs could be reduced by ensuring the details of newly diagnosed reactions to antibiotics are clearly documented. In order for PCPs to overturn more incorrect penicillin records through appropriate use of allergy services, more information and training about these services will be needed.
背景
根据病历记录，有 6%的患者对青霉素过敏。虽然这一标识能保护少数真正过敏的患者免受严重的过敏反应，但那些被错误标识的患者可能会被拒绝使用许多感染的推荐一线治疗药物。消除青霉素过敏的错误标识可能会给个人和普通人群带来积极的健康影响。我们旨在探讨初级保健医生（PCP）和患者对青霉素过敏的看法和理解，重点关注在有青霉素过敏记录的情况下，面对感染时的临床管理。
方法
我们在英格兰北部进行了一项包含 31 名有青霉素过敏记录的患者和 19 名 PCP 的访谈研究。数据采用主题分析法进行分析。
结果
患者通过考虑症状的时间和严重程度来理解他们的过敏状况。青霉素过敏的诊断被报告为“不完美”，PCP 依赖于患者报告和不完整的医疗记录。PCP 和患者经常怀疑过敏记录不正确，但 PCP 不愿意更改记录。PCP 对过敏服务的了解有限。PCP 经常开容易识别的替代抗生素。患者和 PCP 在多大程度上意识到不正确的青霉素过敏记录的潜在后果、其对他们生活的相关性和重要性以及青霉素过敏的管理方面存在差异。
结论
PCP 和患者似乎对不正确的青霉素过敏记录可能带来的危害认识不足。通过确保清楚记录新诊断的抗生素过敏反应的详细信息，可以减少 PCP 遇到的一些问题。为了让 PCP 通过适当利用过敏服务来推翻更多不正确的青霉素过敏记录，需要提供更多关于这些服务的信息和培训。
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