Strategies to Increase Equitable Access to Penicillin Allergy Delabeling Interactions: A Qualitative Study.

Abstract

Patients with unconfirmed and potentially false penicillin allergy labels receive unnecessarily broad-spectrum antibiotics that can lead to worse health outcomes and antimicrobial resistance. While ambulatory care is a favorable setting to engage in penicillin allergy delabeling, the process of removing an incorrect penicillin allergy label has not been widely implemented. To contextualize barriers to and facilitators of penicillin allergy delabeling from a diverse range of perspectives and inform actionable strategies. This qualitative study used in-depth interviews and focus groups with patients who had a penicillin allergy label, clinicians, and other stakeholders from primary care clinics in 3 hospital networks in Boston, Massachusetts. Participants were recruited from March 1 through September 30, 2024. The primary outcome was participant-perceived factors influencing engagement in discussions about penicillin allergy delabeling. The analytic approach was informed by the updated Consolidated Framework for Implementation Research (CFIR), with a mixed inductive-deductive analysis that incorporated the CFIR Expert Recommendations for Implementing Change (ERIC) implementation strategy matching tool to map interview data to implementation strategies. The study included 119 participants (84 [71%] female), of whom 69 (58%) were patients and 50 (42%) were clinicians and stakeholders; 87 (73%) participated in interviews and 32 (27%) participated in focus groups. Six barriers to penicillin allergy delabeling emerged: (1) clinician avoidance of conversations about penicillin allergy labels, (2) patients not being asked about their penicillin allergy labels, (3) language barriers, (4) time constraints, (5) perceived elevated risk of removing a penicillin allergy, and (6) limited access to allergists. These barriers aligned with 5 ERIC strategies: (1) create new ways of delivering care, (2) identify champions, (3) use data experts, (4) alter incentive structures, and (5) conduct educational meetings. This qualitative study guided by implementation science identified strategies to overcome barriers to penicillin allergy delabeling. These strategies may inform the next steps for implementation science research to improve access to penicillin allergy testing and delabeling.