May 15, 2013
Background: Food allergy is a growing and potentially life-threatening concern in the United States that affects an estimated 8% of children. Primary care clinicians are often the first resource for affected families and play a critical role in the diagnosis of children with food allergy. Accordingly, recognition and proper management of food allergy in the primary care setting is critical and may prove life-saving.
Our previous work suggests that primary care clinicians in the US have many misconceptions regarding food allergy management. In addition, physicians themselves expressed concern regarding their ability to manage food allergy effectively. Furthermore, our research shows that one in three children with a convincing history of food-induced reactions have never received a formal diagnosis. Recent results from chart reviews suggest that: 1) physicians are often making a diagnosis of food allergy without obtaining an appropriate clinical history and testing; 2) physicians are not consistently prescribing injectable epinephrine; and 3) little counseling about food allergy management is being documented in the medical record. Goal: To develop and evaluate the feasibility and efficacy of an electronic clinical decision support tool to improve the diagnosis and management of food allergy in the primary care setting. We hypothesize that the development of an evidence-based food allergy clinical decision support tool, optimized for use in clinical practice, will improve the primary care clinical practice of food allergy in children.
Specific Aims: The specific aims of this study are to: 1) Develop a Food Allergy Support Tool (FAST), based on the most recent NIAID guidelines, to improve the diagnosis and management of food allergy in the primary care setting. The FAST will include prompts for symptom recognition, testing, medications, education/counseling, and allergist referral. It will also facilitate patient education by making available allergen-specific materials, in both video and print formats; 2) Test the feasibility of use of the FAST in three pediatric primary care clinics by using rapid cycle process improvement to integrate the FAST into the systems and processes of primary care, and assessing clinicians’ satisfaction and ease of use; and 3) Determine the efficacy of the FAST by evaluating medical record documentation for clinical history of reactions, diagnostic testing and interpretation, medication prescription and instruction in use, counseling and education for patients/caregivers, and referral to an allergist.
Next Steps: This project will result in the development of an evidence-based food allergy support tool (FAST) that will have undergone robust feasibility testing for use in primary care. The outcomes from this project will permit a future randomized control trial of a FAST intervention to families to determine its ability to improve quality of care and health outcomes for children with food allergy.
Funder: National Institute of Allergy and Infectious Diseases
Ruchi Gupta, MD/MPH