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March 01, 2023
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Clinical support tools improve PCP adherence to early peanut introduction guidelines

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SAN ANTONIO — Clinical decision support tools improved primary care providers’ adherence to early peanut introduction guidance during child wellness checks, according to study results.

In 2017, the National Institute of Allergy and Infectious Diseases issued addendum guidelines on the prevention of peanut allergy in infants, following results from the LEAP study that showed early introduction of peanuts reduced peanut allergy among infants.

PC0223Herlihy_AAAAI_Graphic_01_WEB
Data derived from: Herlihy L, et al. Abstract 666. Presented at: AAAAI Annual Meeting; Feb. 24-27, 2023; San Antonio.

However, the current analysis — presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting — follows low physician adherence to these guideline updates. For instance, a study published in 2020 in JAMA Network Open showed that among more than 1,700 pediatricians surveyed, just 64.3% partially and 28.9% fully implemented the guidelines.

Preventing the burden of peanut allergy among patients is what drove researcher Lauren Herlihy, DNP, APRN, CPNP, pediatric nurse practitioner affiliated at University of North Carolina at Chapel Hill, to conduct this study, she told Healio.

“Most of my patients already have the burden of disease. While it is important for me to provide care, education and support to those children and families with peanut allergy, I’m always intrigued and most interested in opportunities that target prevention,” she said. “That really is the hallmark of good pediatric primary care, is ways that we can prevent disease in children.”

To encourage greater implementation of the early peanut introduction guidance, Herlihy and colleagues developed a workflow protocol and clinical decision support tools, which were utilized by pediatric PCPs over the course of 4 months and continuously modified through plan-do-study-act, or PDSA, cycles.

The tools, accessible through electronic medical health records, consisted of:

  • smart lists;
  • visit templates; and
  • educational handouts on home peanut introduction for patients.

During the study’s course, EMR documentation of appropriate early peanut introduction guidance at 4-, 6- and 9-month child wellness checks rose from a mean of 8.8% at baseline to 74.7% after 19 weeks of PDSA cycles (P < .001).

The researchers found that provider adoption of smart lists and templates increased to 67.3%, and the distribution of home peanut introduction handouts increased to 50.2%.

Additionally, the intervention did not impact overall patient experience, with there being no statistically significant changes in the patient’s time in the exam room. DTaP vaccine rates also maintained consistency at 100% at 6-month visits.

Herlihy noted the results were stronger than anticipated.

“We did set some pretty lofty goals with our project aims and outcome, process and balancing measures, but we nearly hit, if not exceeded, all of our projections,” she said. “That speaks to how effective standardized tools can be, particularly when using electronic medical records and a system that allows for patient care to be efficient and streamlined.”

Herlihy pointed out the implications are particularly significant for PCPs, who “are unfairly impacted by time constraints in the primary care setting but who are also responsible for assessing growth, milestones and other developmental concerns. They don’t have time to remember all of the latest guidelines.

“If we can eliminate the need for them to recall important aspects of a visit by designing a tool that prompts providers to be consistent and ask important questions over and over again, provider-to-provider, child-to-child, then that’s not only great care, but that alleviates their burden of everything they need to do in their workflow,” she added.

Because of those potential outcomes, Herlihy defined the focus and project as a PCP “empowerment opportunity for providers to have the confidence and tools to encourage early introduction and prevent peanut allergy in infants.”

For more information:

Lauren Herlihy, DNP, APRN, CPNP, can be reached at lekoch@email.unc.edu.

References: