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Poor adherence to food allergy guidelines reported among pediatricians
Pediatricians should improve their awareness and adherence to guidelines regarding food-allergic children, according to recent study findings published in Clinical Pediatrics.
“Childhood food allergy may be underdocumented in the pediatric clinic,” the researchers wrote. “Among documented cases of food allergy, areas in need of improvement with respect to national guidelines were identified. Guideline adherence was high with respect to specialty referral but was limited regarding documentation of reaction history, appropriate use of diagnostic tests, prescription of epinephrine autoinjectors, and counseling patient families in food allergy management.”
Ruchi S. Gupta, MD, MPH, of Ann and Robert H. Lurie Children’s Hospital of Chicago, and colleagues conducted a parent survey between October 2011 and January 2012 to determine the rate of parent-reported food allergy. Researchers also evaluated the pediatricians’ adherence to national guidelines and evaluated pediatricians’ attitudes regarding non-adherence.
Parents reported food allergy in 10.9% of patients and two-thirds of parents reported food allergy confirmed by physician diagnosis.
Almost three-quarters (74%) of parents reported they had discussed their child’s food allergy with a pediatrician. Those who reported not discussing food allergy gave the following reasons as to why: they had a previous discussion with another pediatrician; thought the food allergy wasn’t severe enough for discussion; thought the child should avoid the food without physician input; and/or more serious health problems were reported.
More than half (59.2%) of patient charts had an appropriate reason documented for suspected food allergy and 81.6% of records had appropriate management documented. Of pediatricians who prescribed an epinephrine autoinjector, all prescribed the appropriate type based on the patient’s weight.
Some pediatricians reported that parents were able to obtain allergist care directly, which may contribute to undocumented cases of food allergy.
Many pediatricians reported that lack of documentation could be more to blame for non-reporting of food allergy than guideline non-adherence. However, some pediatricians reported time constraints led to inappropriate documentation, were unfamiliar with recommended practices, or were unsure of the appropriate role of pediatrician’s in the management of childhood food allergy.
“Appropriate management by the pediatrician is critical, as they are often the only health care providers for these children; even if children are referred to an allergist, the wait time is on average 4 months,” the researchers wrote. “Findings emphasize the need to better establish the role of the pediatrician in the care of food-allergic children, and the need to provide additional clinical support to improve awareness and adherence to established practice guidelines.”
Disclosure: The study was funded in part by Northwestern University Clinical and Translational Sciences Institute.
