Penicillin Allergy Delabeling in Pediatric Primary Care: A Multisite Qualitative Study

Area of Science:

• Pediatric Allergy and Immunology
• Primary Care Medicine
• Health Services Research

Background:

• Penicillin allergy (PA) delabeling is recommended for low-risk children, with growing evidence for its safety in pediatric primary care settings.
• Primary care practitioners' perspectives are crucial for understanding and implementing PA delabeling initiatives.
• This study explores primary care practitioners' attitudes, perceived barriers, and enablers for PA delabeling.

Purpose of the Study:

• To identify primary care practitioners' attitudes towards penicillin allergy delabeling in children.
• To explore perceived barriers and enablers to implementing PA delabeling in primary care settings.
• To inform the development of interventions supporting PA delabeling in pediatric primary care.

Main Methods:

• Semi-structured interviews and focus groups were conducted with 29 primary care practitioners across two health systems.
• Content analysis was used to code interview and focus group transcripts.
• Barriers and enablers were mapped to the Capability, Opportunity, and Motivation (COM-B) model.

Main Results:

• Practitioners recognized the benefits of PA delabeling for children and reported previous attempts at delabeling.
• Identified barriers included lack of skills/training (capability), caregiver resistance, and inadequate time/staff/space (opportunity).
• Motivation to delabel was mixed, influenced by perceived barriers.

Conclusions:

• Primary care practitioners view PA delabeling as beneficial for pediatric health.
• Interventions should focus on enhancing practitioner skills, securing caregiver engagement, and optimizing resources (time, space).
• Collaboration with allergists for delabeling protocols is recommended to facilitate implementation in primary care.