Patient-related factors drive high rates of reported antibiotic allergies: A qualitative study

Abstract

Patient-related factors drive high rates of reported antibiotic allergies: A qualitative study Renee Berry a, Susan Herrmann c, Michaela Lucas a,b,c,* a Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia b Immunology Laboratory, PathWest, QEII Medical Centre, Perth, Western Australia, Australia c Medical School, University of Western Australia, Perth, Western Australia, Australia A R T I C L E I N F O Handling Editor: Prof A Angelo Azzi Keywords: Antibiotic allergy Patient perspective Qualitative A B S T R A C T Background: Unnecessary antibiotic avoidance due to allergy fears has adverse cost and health implications however, the problem is difficult to resolve because patient and provider-related factors leading to avoidance are multifactorial. We use qualitative research methods to explore patient perspectives of antibiotic allergy and testing to reach the heart of the problem. Objective: To reveal factors leading patients to report antibiotic allergy, and determine what education is required to prevent the cycle of erroneous allergy reporting. Methods: The 29 patients were a sample of convenience recruited from a tertiary public hospital in Western Australia between March 2020 until August 2020; 18 were inpatients and 11 outpatients, with a median age of 64.2 years, and 15 (55%) were female. Semi-structured interviews assessed patients’ understanding and knowledge of three topics: (1) antibiotic allergy, (2) antibiotic allergy testing, and (3) outcomes of testing. Interview transcripts underwent thematic analysis by two researchers, independently. Results: Three main, overlapping themes emerged as influential across topics: (1) Severity of the Index Reaction, (2) Trust in family and health care providers, and (3) Health literacy. Patients were largely unaware of the benefits of confirmatory testing, and the detrimental health consequences of unnecessary avoidance. Patients displayed trust in health care providers’ expertise and assumed that medical records were accurate to prevent prescribing errors. Conclusions: The findings provide evidence for an effective patient education strategy and highlight failures among hospital and primary health providers to recognise the potential harm of unverified antibiotic allergy. Healthcare professionals are influential at multiple steps of a patient’s healthcare journey and addressing unconfirmed antibiotic allergy should be taken at each opportunity.