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Inappropriate Antibiotic Allergy Documentation in Health Records: A Qualitative Study on Family Physicians' and
Kitty De Clercq1, Jochen W L Cals1, Eefje G P M de Bont2
1Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre, The Netherlands.
Purpose:
It is hypothesized that 90% of antibiotic allergies documented in patients' health records are not actual, potentially life threatening, type I allergies mediated by IgE. This distinction is important because such documentation increases antibiotic resistance, as more second-choice and broad-spectrum antibiotics are then used. Evidence is lacking regarding causes of this inappropriate documentation. To develop interventions aimed at improving documentation, we explored experiences of family physicians and pharmacists in this area.
Methods:
We conducted a qualitative study among family physicians and pharmacists using focus group discussions, based on purposeful sampling and a naturalistic approach. Discussions were audio-recorded, transcribed verbatim, and analyzed in duplicate by means of constant comparative technique.
Results:
We conducted 4 focus group discussions among 34 family physicians and 10 pharmacists, from which 3 main themes emerged: (1) magnitude and awareness of the problem of inappropriate antibiotic allergy documentation, (2) origin of the problem, and (3) approaches for addressing the problem. Participants noted that the magnitude of contamination of medical files with inappropriate documentation leads to skepticism about current documentation. Major hindering factors are electronic health record systems and electronic communication. In addition, family physicians and pharmacists believed they had insufficient knowledge about antibiotic allergies and called for tools to rectify inappropriate allergy documentation and facilitate proper documentation going forward.
Conclusions:
Family physicians and pharmacists perceive that few documented antibiotic allergies are in fact correct. Electronic health record barriers and communication barriers, as well as a lack of knowledge and facilitating tools, are main causes for numerous inappropriately documented antibiotic allergies and therefore targets for improving documentation in the future.
Insights
Most documented antibiotic allergies are incorrect, leading to increased antibiotic resistance. Electronic health records and communication issues, plus a lack of knowledge, contribute to this problem, requiring new tools for accurate allergy documentation.
Area of Science:
- Clinical Pharmacy
- Infectious Diseases
- Health Informatics
Background:
- A significant proportion of documented antibiotic allergies may not represent true IgE-mediated reactions.
- Inaccurate allergy documentation contributes to the overuse of broad-spectrum and second-line antibiotics, exacerbating antibiotic resistance.
- Understanding the root causes of erroneous antibiotic allergy documentation is crucial for developing effective interventions.
Purpose of the Study:
- To explore the experiences of family physicians and pharmacists regarding inappropriate antibiotic allergy documentation.
- To identify factors contributing to the inaccurate recording of antibiotic allergies in patient health records.
- To inform the development of interventions for improving the accuracy of antibiotic allergy documentation.
Main Methods:
- A qualitative study design was employed, utilizing focus group discussions.
- Participants included family physicians and pharmacists, recruited through purposeful sampling.
- Data were analyzed using a constant comparative technique after verbatim transcription of audio recordings.
Main Results:
- Three key themes emerged: awareness of the problem, its origins, and potential solutions.
- Participants expressed skepticism regarding the accuracy of current antibiotic allergy documentation due to widespread "contamination" of records.
- Hindering factors identified include electronic health record systems, communication challenges, and insufficient knowledge about antibiotic allergies.
Conclusions:
- Family physicians and pharmacists believe most documented antibiotic allergies are inaccurate.
- Barriers in electronic health records and communication, coupled with knowledge gaps and a lack of tools, are primary drivers of incorrect documentation.
- Addressing these barriers and providing better tools are essential for improving future antibiotic allergy documentation.
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