Improving Equitable Access to Penicillin Allergy De-Labeling

项目摘要 降低抗生素耐药（AMR）感染死亡率的全球公共卫生战略 鼓励删除不准确的青霉素（PCN）过敏标签，称为“去标签”。PCN过敏去标签 推荐的是约10%的人报告PCN过敏，但只有5%的人（即，<1%）拥有真正的PCN 经正式检测后确认过敏。PCN过敏患者的替代抗生素处方 标签导致较差的临床结果，增加不良事件，包括艰难梭菌感染， 耐甲氧西林金黄色葡萄球菌增加，医疗保健费用增加。PCN过敏de- 标签是一种基于证据的策略，可以减少暴露于更广谱和次优的 抗生素，有可能减少多重耐药性和医疗保健相关的感染，挽救生命。最 在急性护理环境中，改善PCN过敏去除标签的努力一直是反应性的， 抗生素需求，而不是在门诊护理环境中积极主动。此外，PCN过敏去标签化工作 迄今为止，尽管少数民族社区的AMR率最高，但尚未关注卫生保健公平性。 这项申请的重点是确定可行和可接受的战略，以增加公平获得 PCN过敏去除标签。我们的长期目标是减少AMR感染，有目的地关注 减少与感染相关的健康差距。这项研究考虑了波士顿的三个医院网络 服务于不同的社区，并与不同的过敏专家接触，以改善 公平获得PCN过敏去除标签。我们的具体研究目标包括：1）确定患者， 与PCN过敏去标签相关的社会、临床医生和机构因素; 2）调查障碍， 在初级保健中用定性方法促进PCN过敏去标签化;和3）识别，提炼， 评估实施战略，以增加公平获得多氯化萘过敏去除标签。 为了实现这些目标，我们利用由领导者组成的多学科研究团队， 传染病、过敏/免疫学、初级保健和健康差异， 在大型数据库研究，定性研究和实施科学的专业知识。本申请是 响应PA-22-047，符合AHRQ的使命，以及我们对改善健康的普遍承诺 我们的目标是提供更好的卫生保健，使卫生保健更加公平，并减少全球抗菌素耐药性危机。

Project Summary The global public health strategy to decrease mortality from antimicrobial resistant (AMR) infections encourages removal of inaccurate penicillin (PCN) allergy labels, termed “de-labeling.” PCN allergy de-labeling is recommended as ~10% of all people report a PCN allergy, but only 5% of those (i.e., <1%) have a true PCN allergy confirmed after formal testing. Prescription of alternative antibiotics in individuals with PCN allergy labels results in inferior clinical outcomes, increased adverse events including Clostridioides difficile infection, increased methicillin-resistant Staphylococcus aureus, and increased health care costs. PCN allergy de- labeling is an evidence-based strategy that can decrease exposure to more broad-spectrum and suboptimal antibiotics, potentially reducing multi-drug resistant and healthcare-associated infections and saving lives. Most efforts to improve access to PCN allergy de-labeling have been reactive in acute care settings at the time of antibiotic need, rather than proactive in ambulatory care settings. Furthermore, PCN allergy de-labeling efforts to date have not focused on health care equity despite AMR rates being highest in minoritized communities. This application focuses on identifying feasible and acceptable strategies to increase equitable access to PCN allergy de-labeling. Our long-term goal is to decrease AMR infections with a purposeful focus on reducing infection-associated health disparities. This study considers three Boston-based hospital networks serving diverse communities and with disparate allergy specialist access for studies that aim to improve equitable access to PCN allergy de-labeling. Our specific research aims include: 1) determining patient, societal, clinician, and institutional factors associated with PCN allergy de-labeling; 2) investigating barriers and facilitators to PCN allergy de-labeling in primary care with qualitative methods; and 3) identification, refining, and evaluating implementation strategies to increase equitable access to PCN allergy de-labeling. To achieve these aims, we leverage a multidisciplinary research team comprised of leaders in infectious diseases, allergy/immunology, primary care, and health disparities with broad methodologic expertise in large database research, qualitative research, and implementation science. This application is responsive to PA-22-047, aligns with the mission of AHRQ, and our universal commitments to improve health care, make health care more equitable, and reduce the global crisis of antimicrobial resistance.