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Methods: 173 patients received and filled an SIE prescription between 2002-2003 at the VA West Los Angeles Medical Center; 82 were active in December 2013 and contacted for a telephone survey. Survey questions included SIE indication, confidence level, instructions on proper SIE use, accessibility of SIE, review of use on follow-up visits, and frequency of use.
Results: In total, 38 patients participated in the telephone survey. Initial instructions for SIE use were provided to 81.6% of patients; 86.8% reported rarely/never receiving review of instructions on follow-up visits. Reasons for lack of confidence included inadequate education regarding use (71.4%) and inability to recall instructions (26.6%). Immediate access to SIE 100% of the time was reported in 47.1% and 15.4% of patients with insect venom allergy and food allergy, respectively, and immediate access to SIE <50% of the time was reported in 23.5% and 69.2%, respectively. Reasons for non-adherence were: belief that SIE was unnecessary (55.6%), inconvenience (33.3%), and lack of reminder by physician (11.1%). Overall, 42 episodes of anaphylaxis symptoms were reported by 10 patients; SIE was used in 41 episodes and 911 was called in 27 encounters. All patients who used SIE stated it improved their outcome.
Conclusions: Our survey suggests that there is an opportunity for physicians to improve SIE adherence by educating patients on SIE use and reviewing instructions on follow-up visits, thereby potentially increasing patient confidence in SIE use.