1. Clinical decision support tools may improve pediatrician guideline adherence for peanut allergy prevention
Evidence Rating Level: 3 (Average)
The National Institute for Allergy and Infectious Disease recommends that clinicians screen infants age 4 to 6 months for peanut allergy (PA). In addition, it is recommended that infants deemed to be high risk (i.e. those with severe eczema and/or egg allergy) receive a specific IgE or allergy referral for assessment before they are introduced to peanut products. Clinical decision support (CDS) tools can help facilitate physician adherence to clinical guidelines. The Intervention to Reduce Early (Peanut) Allergy in Children (iREACH) initiative includes pediatrician training and CDS tools (i.e. order set for peanut specific IgE, allergy referral for high risk infants) implemented in electronic medical records (EMR) for well-child visits for infants age 4 to 6 months. In this study, researchers compared pediatrician adherence to peanut allergy prevention guidelines between a pediatric clinic that received the iREACH training module and CDS tool, to a second comparison clinic that received no EMR modification or training. At the iREACH clinic, data from 151 infants was collected and compared to a random sample of 312 infants from the comparison clinic. Of note, there were significant differences in demographic factors between the clinics where at the iREACH clinic there were more male infants (63.6% vs. 50.3%, p=0.007), more infants identified as black (29.8% vs. 0.6%, p<0.001) or of multiple/other races (49.0% vs. 8.3%, p<0.001). Researchers found that for infants at low-moderate risk, pediatricians were fully adherent to guidelines for 52.4% of infants in the iREACH clinic, as compared to 14.1% in the comparator clinic (p<0.001). Partial adherence was noted for 93.0% of infants in the iREACH clinic. For infants identified as high-risk, pediatrician adherence was 62.5%. Due to the limited sample size of high-risk infants at the comparator clinic, however, a difference could not be appreciated (p=0.44). As such, this study was limited by the small number of clinic sites studied and marked differences between infants seen at each clinic. Nonetheless, this study shows that improved pediatrician guideline adherence for peanut allergy prevention may be achieved with the use of CDS tools.
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