METHODS: A questionnaire was distributed to 54 pediatric residents at the Mount Sinai Hospital primary care clinic. Questions included demographics, practice patterns, and barriers to action plan use.
RESULTS: The survey response rate was 67% (n=36), with 36% in postgraduate year (PGY)-1, 36% in PGY-2, and 28% in PGY-3. Most physicians did not have a personal history of allergy (83%) or prior exposure to an allergy elective (88%). Almost all (92%) had seen a case of food allergy or insect-sting allergy, and agreed that written action plans would be beneficial to families for managing severe allergic reactions (64%). However, only 19% have provided action plans to patients and their families, and only 6% consistently provided action plans when prescribing epinephrine auto-injectors. Forty-two percent of responders were unaware of pre-existing action plan templates, and few (22%) feel comfortable completing action plans. Fifty-six percent of responders report providing verbal counseling on anaphylaxis consistently. Reported barriers to anaphylaxis action plan use included: practice-related factors (“short visit time,” “workflow difficulties”), compartmentalization of medical care delivery (“allergy referral was provided instead”), clinical history (“mild allergic reactions”), and patient-related factors (“low family literacy”).
CONCLUSIONS: Multiple physician, patient and practice-related barriers contribute to low utilization of anaphylaxis action plans in a primary care setting. Future education and systems-based interventions may help increase its usage.