Department of Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, 53792-7375, WI, USA.
William S. Middleton Veterans Memorial Hospital Madison, Madison, WI, USA.
BMC Health Serv Res. 2024 Aug 26;24(1):987. doi: 10.1186/s12913-024-11364-7.
Penicillin allergy is the most frequently reported drug allergy, yet most patients can tolerate the drug if challenged. Despite this discrepancy, large scale penicillin allergy de-labeling interventions have not been widely implemented in many health care systems. The application of a multi-method implementation science approach can provide key tools to study this evidence to practice gap and provide insight to successfully operationalize penicillin allergy evaluation in real-world clinical settings.
We followed a four-step process that leverages qualitative analysis to design evidence-based, actionable strategies to develop an intervention. First, we specified the clinician-perceived barriers to penicillin allergy de-labeling (intervention targets). We then mapped intervention targets onto Theoretical Domains Framework (domains and constructs) and found the root causes of behavior. Next, we linked root causes of behavior with intervention functions (BCW). In the final step, we synthesized participants' suggestions for process improvement with implementation strategies aligning with the intervention functions.
Evidence-based strategies such as focused education and training in penicillin allergy evaluation can address knowledge and confidence barriers reported by frontline clinicians. Other key strategies involve developing a system of champions, improving communications systems, and restructuring the healthcare team. Implementation mapping can provide a powerful multi-method framework to study, design, and customize intervention strategies.
Empowering clinicians beyond allergy specialists to conduct penicillin allergy assessments requires designing new workflows and systems and providing additional knowledge to those clinicians.
青霉素过敏是最常报告的药物过敏，但大多数患者如果受到挑战，仍能耐受该药物。尽管存在这种差异，但在许多医疗保健系统中，大规模的青霉素过敏去标签干预措施并未广泛实施。应用多方法实施科学方法可以为研究这一证据与实践差距提供关键工具，并深入了解如何在现实临床环境中成功实施青霉素过敏评估。
我们遵循了一个四步流程，利用定性分析来设计基于证据的、可操作的策略来开发干预措施。首先，我们确定了临床医生认为的青霉素过敏去标签障碍（干预目标）。然后，我们将干预目标映射到理论领域框架（领域和结构）上，并找到了行为的根本原因。接下来，我们将行为的根本原因与干预功能（BCW）联系起来。在最后一步，我们综合了参与者对改进流程的建议和与干预功能相一致的实施策略。
基于证据的策略，如针对青霉素过敏评估的集中教育和培训，可以解决一线临床医生报告的知识和信心障碍。其他关键策略包括培养拥护者系统、改善沟通系统和重组医疗团队。实施映射可以为研究、设计和定制干预策略提供一个强大的多方法框架。
要使非过敏专科医生能够进行青霉素过敏评估，需要设计新的工作流程和系统，并向这些临床医生提供额外的知识。
