IMPLEMENTATION SCIENCE FRAMEWORK-GUIDED ASSESSMENT OF CLINICIAN STRATEGIES TO IMPROVE EQUITABLE ACCESS TO PENICILLIN ALLERGY DE-LABELING

Abstract

Introduction

Most people with penicillin allergy labels are not truly allergic. Incorrect penicillin allergy labels lead to unnecessary use of broad-spectrum costly antibiotics, drug-resistance, and morbidity. Primary care clinicians document allergies, but the process of removing allergies (de-labeling) is not routine. Implementation science frameworks provide a systematic approach to identifying and contextualizing barriers and facilitators to penicillin allergy de-labeling.

Methods

Using an equity-focused adaptation of the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with thirty clinicians from six primary care clinics in the greater Boston area. Robust qualitative methodology guided mixed inductive and deductive coding of interviews that were mapped to themes and CFIR domains.

Results

Four themes emerged: competing priorities, time constraints, fear of negative consequences, and clinical staff role ambiguity. Applying an equity lens, clinicians identified patient factors, including increased number of co-morbid illnesses and speaking languages other than English, creating additional time constraints preventing penicillin allergy de-labeling. These themes mapped most directly to the Inner Setting domain (work infrastructure, human equity-centeredness, and recipient-centeredness) and the Outer Setting domain (external, societal, and market pressures). Strategizes suggested by clinicians included clarifying/expanding the medical assistant role for initiating penicillin allergy de-labeling and leveraging informational technology tools to identify patients for de-labeling.

Conclusion

Implementation science methods can be used to identify barriers and related strategies to improve equitable access to penicillin allergy de-labeling. The next step will leverage partnerships with primary care clinicians and practice administrators to facilitate implementation strategies to increase penicillin allergy de-labeling in primary care.