Improving Equitable Access to Penicillin Allergy De-Labeling

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.