Food Allergies in a Pediatric Clinic – Interventions to Improve Management

Rationale: The growing prevalence of food allergies among children indicates a responsibility among general pediatricians to ensure that their patients receive accurate diagnosis and management. We hypothesized that implementation of educational and electronic medical record (EMR) interventions would improve physician knowledge and management of food allergies. 

Methods: Pre and post-test scores of pediatric residents and faculty were analyzed to assess effectiveness of an educational session designed to improve knowledge of food allergy management. One year later, a best practice advisory was implemented in the EMR alerting providers to consider allergy referral whenever a diagnosis code for food allergy or epinephrine autoinjector prescription was entered. A review of charts 6 months prior to and 6 months after each intervention was completed to determine the impact of both interventions. Outcome measurements included referrals to allergy clinic, prescription of self-injectable epinephrine, and documentation that written emergency action plans were provided. 

Results: There was a significant increase in test scores immediately after the educational intervention (mean 56.2% vs. 84.3%, p <0.001). Post-test scores remained significantly higher than pre-intervention scores 6 months later (mean score 68.0% vs 56.2%, p=0.006). Although knowledge improved, there was no significant difference in the percentage of patients who were provided allergy referral, prescribed an epinephrine autoinjector, or given an emergency action plan before and after both interventions. 

Conclusions:  Neither intervention resulted in improvements in the management of children with food allergies at our general pediatrics clinic. Further studies are needed to identify effective strategies to improve management of food allergies by general pediatricians.