122 Chapter 5 the coding. Any discrepancies in coding were resolved by discussion. If consensus could not be reached, a third reviewer was asked to resolve any outstanding issues (F.B.). The identified determinants were structured into a framework according to the themes in the checklist of Flottorp. Results Analysis of the quality of antibiotic allergy registrations in primary care The ELAN data warehouse contained routine registry data on 196,038 enlisted patients (0–102 years) at the time of analysis. The prevalence of registered patients with an antibiotic allergy registration was 3.2% (6368/196,038), encompassing 11,841 antibiotic allergy registrations in total (Table 1). Of the 6368 patients with an antibiotic allergy registration, 2034 had multiple registrations, ranging from 2 to 22 per patient. Penicillin allergy was the most frequently registered antibiotic allergy, 45.0% (95% CI from 44.1% up to 45.9%). Assessment of 300 antibiotic allergy registrations using the modified Salden checklist showed that none of these registrations were complete (Table 2). Information on the time course of symptoms were missing in 80% of cases. According to the Salden criteria, diagnosis of an antibiotic allergy was correct in 29.3% (n = 88/300) of registrations (Table 3). In 14.3% (n = 43/300) of cases, a non-allergic reaction was incorrectly registered as an antibiotic allergy. Semi-structured interviews In total, 31 primary care physicians (PCP), 4 medical specialists (MS), 11 Elderly Care physicians (ECP), 5 elderly care nurses (ECN) and 4 Pharmacists or pharmacy technicians (PH) were invited to participate. Data saturation was reached after interviews with 10 PCPs, 4 MSs, 11 ECPs, 5 ECNs and 4 PHs, of whom 56% was female and 53% had more than 10 years’ experience. The MS consisted of a surgeon in training, a hospital physician and 2 gastroenterologists. Transcripts were analysed according to the threestep plan described in the methods (Fig 1 and Table 4). Individual characteristics of care providers All healthcare providers stated that side effects were sometimes registered as allergies, with the interviewees explaining that side effects were interpreted as allergies either due to lack of knowledge, medical uncertainty and/or fear of medical liability. In all
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