61% of caregivers know how to correctly use an epinephrine autoinjector

Key takeaways:

• 96.1% of caregivers said they know how to use their child’s autoinjector.
• 33.1% of caregivers removed the injector too soon in demonstrations.
• Competence varied by education, income and previous experience.

Epinephrine autoinjector administration competence varied among caregivers, indicating a need for better education, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

Sociodemographic factors were associated with correct administration as well, Evelyn Zhang, BS, student, Icahn School of Medicine at Mount Sinai, and colleagues wrote.

The prospective study included 154 caregivers (85.7% women) of patients aged younger than 19 years with a history of food allergy and an epinephrine autoinjector prescription. In a survey given during their child’s appointment, 96.1% of caregivers said they knew how to use their child’s autoinjector.

Next, the researchers asked caregivers to demonstrate how they would use their child’s autoinjector with a corresponding training device. Autoinjector models included Kaléo’s Auvi-Q, Mylan’s EpiPen, Teva’s generic version of the EpiPen, and Amedra’s Adrenaclick.

Caregivers had to complete four universal steps — removing all safety caps before injection, placing the correct end on the patient’s body, pushing down to inject, and holding the autoinjector in place for the minimum appropriate time — to use it correctly.

Overall, 61% of caregivers correctly used the autoinjector, including 87.9% of those who used the Auvi-Q, 41.7% of those who used the EpiPen, 45% of those who used the Teva autoinjector and 25% of those who used the Adrenaclick.

The caregivers most often made mistakes when they had to hold the autoinjector in place during the injection, with 33.1% removing it too soon. Also, 22.1% of them failed to press the autoinjector down completely during the injection.

Rates of incorrect demonstrations also included 32.2% for white caregivers, 17.6% for Asian caregivers, 66.7% for Black caregivers, 25.9% for mixed non-Hispanic caregivers and 55.6% for Hispanic caregivers.

Additionally, 37.1% of mothers and 50% of fathers had incorrect demonstrations, as did 27% of those on private insurance and 74.4% of those on public insurance.

Results varied by caregiver education as well, with incorrect demonstrations by 29.1% of those with a postgraduate degree, 44.9% of those with a bachelor’s degree, 52.6% of those with some college and 71.4% of those with a high school diploma or less.

Rates of incorrect demonstrations further included 27.9% by those with family incomes of more than $150,000, 34.5% by those between $100,000 and $150,000, 68.7% by those between $50,000 and $100,000 and 64.2% by those with less than $50,000.

Caregivers who had owned an epinephrine autoinjector for at least 5 years and who had previously used one before were also more likely to use one correctly, as were those who had learned how to use it from a medical provider and those who had learned through an in-person demonstration with a training device.

After controlling for confounders, the strongest predictors for correct use included private medical insurance (adjusted OR = 1.3; 95% CI; 95% CI, 1.09-1.54), owning an epinephrine autoinjector for at least 5 years (aOR = 1.28; 95% CI, 1.09-1.5), owning an Auvi-Q (aOR = 1.14; 95% CI, 1.05-1.25) and in-person demonstrations (aOR = 1.21; 95% CI, 1.03-1.42).

Preferences for caregiver education included in-person demonstrations with a training device (87%), video (41.6%), and verbal (5.2%) and written instructions (9.7%).

These findings suggest that allergists and pediatricians should model correct epinephrine autoinjector use during visits, the researchers said, especially when sociodemographic factors indicate risks for incorrect use.

The researchers also said that providers should prioritize assessments of how well caregivers understand each step of autoinjector administration, considering the difference between the caregivers who said they knew how to correctly use one and those who demonstrated correct use.

In fact, the researchers continued, providers should emphasize proper education with training devices during all their interactions with patients with food allergy, considering the number of different brands of autoinjectors on the market.

The researchers recommended further studies into the efficacy of different educational interventions designed to increase knowledge of epinephrine autoinjector use among various communities of pediatric patients with food allergy as well.