Health disparities investigated in a primary care penicillin allergy removal pathway.

Abstract

Background: Unconfirmed penicillin allergies over time lead to poor health outcomes and increased health-care cost. Health disparities (HD) can create barriers in optimizing penicillin allergy care. Objective: The objective was to characterize HDs in our primary care-led amoxicillin challenge (PLAC) delabeling pathway within a universal coverage health care system. Methods: In three outpatient clinic sites, 41,104 patients were screened, and 1,749 patients were discovered to have penicillin allergies. Of the 1,749 patients with penicillin allergy, 336 (ages 4 months to 76 years) were determined to be candidates for PLAC. A retrospective chart review was completed after 1 year of PLAC implementation to compare demographic characteristics and HD core categories (neighborhood living type, economic stability, background education status, and access to care) between those who completed and those who did not complete their PLAC appointment. All candidates underwent the same PLAC protocol and had universal health coverage that reduced health cost. Results: Of 336 PLAC candidates (45.8%), 154 presented for their PLAC appointment and had their penicillin allergy removed without adverse outcomes. One hundred and eighty-two candidates (54.2%) did not complete a PLAC appointment and retained their penicillin allergy label. Candidates who did not complete their PLAC appointment were older (p = 0.001) and white (p = 0.006), and did not identify as officers (p = 0.04). There was no significant difference in neighborhood type or gender between the groups. In candidates ages ≥ 19 years, those without proactively scheduled appointments more commonly (p < 0.001) did not complete their PLAC appointment; whereas proactive scheduling increased delabeling from 5.8% to 91.3% in candidates ages ≥ 19 years. Of the 199 candidates with proactively scheduled PLAC appointments, those with less perceived economic stability and background education status (enlisted members) were more likely not to attend their PLAC appointment (p < 0.001). Conclusion: Results of our study suggest that our PLAC protocol provides a foundation of decreased HDs to successfully delabel patients at low risk of penicillin allergy when scheduling appointments for all and controlling for health-care cost.