Direct oral penicillin challenge in secondary care with low-risk patients: the SPACE mixed-methods study with cost-effectiveness analysis DOI Creative Commons
Mamidipudi Thirumala Krishna, Yogini Jani, Iestyn Williams

et al.

Health and Social Care Delivery Research, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 96

Published: April 1, 2025

Some text in this abstract has been adapted from Krishna MT, Bhogal R, Ng BY, Kildonaviciute K, Jani YH, Williams I, et al . A multicentre observational study to investigate feasibility of a direct oral penicillin challenge de-labelling ‘low risk’ patients with allergy by non-allergy healthcare professionals (SPACE study): Implications for systems. J Infect 2024; 88 :106116. https://doi.org/10.1016/j.jinf.2024.01.015. This is an Open Access article distributed accordance the terms Creative Commons Attribution (CC BY-NC-ND 4.0) license. See: https://creativecommons.org/licenses/by-nc-nd/4.0/. The below includes minor additions and formatting changes original text. Background One five inpatients carries label. However, 90–95% labels are incorrect. Penicillin lead increased risk serious hospital infections longer stay associated higher estimated costs. testing onerous requires specialist. Routine inpatient not available. Recent evidence suggests that delivered specialists safe patients, who highly unlikely be allergic based on history. Aims To explore behaviour, attitudes acceptability managers regarding patients. inform development implementation framework determine potential cost-effectiveness. Methods (1 May 2021–30 April 2023) involved delivery across three clinical settings (medical/infectious diseases wards, presurgical haematology-oncology units) at hospitals. had workstreams: Workstream 1: Screening suitability. Patients were stratified into ‘high risk’. ‘Low-risk’ underwent challenge. 2: One-to-one semistructured interviews ( N = 43) focus group 28) discussions stakeholders. 3: Care pathway mapping, decision-analytic modelling value information analysis carried out cost-effectiveness Results thousand fifty-four 2257 screened eligible, 270 643 approached consented (42%). Two hundred fifty-nine risk-stratified (155 risk’; 104 risk’). Of 155 126 challenge, 122 (97%) de-labelled no reactions 43 interviewed. Low-risk accepted their labels, limited knowledge adverse impact most keen have reviewed. Healthcare demonstrated risk-averse approach, although would engage intervention training, resource availability governance place. total costs than alone (£940 vs. £98–288 per patient). There minimal expected savings antibiotic short term potentially large cost over 5 years. Limitations Relatively small sample size poor conversion rate, particularly acute settings, English language proficiency could included was sufficiently powered controlled conduct evaluation. Conclusions first United Kingdom showed specialist-led feasible secondary care. high proportion challenges successful, positive feedback Majority did progress through pathway. Going forward, multipronged approach needed enhance equitability routine practice. Follow-up mechanisms consider during clinically stable state those lacking capacity consent needed. delivering its entirety significantly performing se. Future work randomised trial long-term follow-up Study registration registered as ISRCTN55524365. Funding award funded National Institute Health Research (NIHR) Social Delivery programme (NIHR ref: NIHR129069) published full ; Vol. 13, No. 9. See NIHR Awards website further information.

Language: Английский

Direct oral penicillin challenge in secondary care with low-risk patients: the SPACE mixed-methods study with cost-effectiveness analysis DOI Creative Commons
Mamidipudi Thirumala Krishna, Yogini Jani, Iestyn Williams

et al.

Health and Social Care Delivery Research, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 96

Published: April 1, 2025

Some text in this abstract has been adapted from Krishna MT, Bhogal R, Ng BY, Kildonaviciute K, Jani YH, Williams I, et al . A multicentre observational study to investigate feasibility of a direct oral penicillin challenge de-labelling ‘low risk’ patients with allergy by non-allergy healthcare professionals (SPACE study): Implications for systems. J Infect 2024; 88 :106116. https://doi.org/10.1016/j.jinf.2024.01.015. This is an Open Access article distributed accordance the terms Creative Commons Attribution (CC BY-NC-ND 4.0) license. See: https://creativecommons.org/licenses/by-nc-nd/4.0/. The below includes minor additions and formatting changes original text. Background One five inpatients carries label. However, 90–95% labels are incorrect. Penicillin lead increased risk serious hospital infections longer stay associated higher estimated costs. testing onerous requires specialist. Routine inpatient not available. Recent evidence suggests that delivered specialists safe patients, who highly unlikely be allergic based on history. Aims To explore behaviour, attitudes acceptability managers regarding patients. inform development implementation framework determine potential cost-effectiveness. Methods (1 May 2021–30 April 2023) involved delivery across three clinical settings (medical/infectious diseases wards, presurgical haematology-oncology units) at hospitals. had workstreams: Workstream 1: Screening suitability. Patients were stratified into ‘high risk’. ‘Low-risk’ underwent challenge. 2: One-to-one semistructured interviews ( N = 43) focus group 28) discussions stakeholders. 3: Care pathway mapping, decision-analytic modelling value information analysis carried out cost-effectiveness Results thousand fifty-four 2257 screened eligible, 270 643 approached consented (42%). Two hundred fifty-nine risk-stratified (155 risk’; 104 risk’). Of 155 126 challenge, 122 (97%) de-labelled no reactions 43 interviewed. Low-risk accepted their labels, limited knowledge adverse impact most keen have reviewed. Healthcare demonstrated risk-averse approach, although would engage intervention training, resource availability governance place. total costs than alone (£940 vs. £98–288 per patient). There minimal expected savings antibiotic short term potentially large cost over 5 years. Limitations Relatively small sample size poor conversion rate, particularly acute settings, English language proficiency could included was sufficiently powered controlled conduct evaluation. Conclusions first United Kingdom showed specialist-led feasible secondary care. high proportion challenges successful, positive feedback Majority did progress through pathway. Going forward, multipronged approach needed enhance equitability routine practice. Follow-up mechanisms consider during clinically stable state those lacking capacity consent needed. delivering its entirety significantly performing se. Future work randomised trial long-term follow-up Study registration registered as ISRCTN55524365. Funding award funded National Institute Health Research (NIHR) Social Delivery programme (NIHR ref: NIHR129069) published full ; Vol. 13, No. 9. See NIHR Awards website further information.

Language: Английский

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