Utilization of Anaphylaxis Action Plans and Barriers to Use in Primary Care Pediatrics

RATIONALE: Written action plans serve as important tools for anaphylaxis education and treatment, and are recommended by food allergy guidelines. We investigated the current utilization of anaphylaxis action plans and associated barriers in primary care pediatrics.

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.