123 Cues to improve antibiotic-allergy registration: A mixed-method stu 5 domains, healthcare providers admitted a lack of knowledge regarding distinguishing side effects from various types of antibiotic allergies. Interviewees who were aware of the issue of incorrect antibiotic allergy registrations, were more likely to verify existing registrations. They also indicated that these processes require education concerning antibiotic allergies and expressed a wish for more educational opportunities. Patient factors Patient factors, such as cognitive impairment or aphasia, hinder verification and classification of previously registered allergies. This problem was mentioned in particular by ECPs. According to interviewees, the patient’s preferences and personal interpretation of symptoms lead to incorrect registrations. Patients sometimes prefer not to be prescribed a specific antibiotic based on previous experiences, i.e. side effects. This can lead to incorrect antibiotic allergy registration, but prevents patient exposure to the antibiotic. Professional interactions Interviewed PCPs reported hardly any problems regarding communication of antibiotic allergies with other healthcare providers both ways, stating that most communication was digital through their EMRs and was sufficient in their opinion. Interviewed PCPs also mentioned that more elaborate communication was mainly confined to pharmacists but was hindered by lack of time. Other healthcare providers occasionally experienced difficulties in communication, stating that EMR registrations were sometimes incomplete, referral letters were missing essential details. Reaching other healthcare providers to obtain missing information was time-consuming. Together, these issues made it difficult to verify an antibiotic allergy registration. According to PCPs, another barrier for correct registration of antibiotic allergies was limited availability or access to diagnostic tests, in addition to (presumed) long waiting lists for referral to an allergist. Incentives and resources Lack of time hindered complete and correct registration of new antibiotic allergies. Furthermore, lack of time often led to healthcare providers failing to verify whether an existing antibiotic allergy registration was correct. Many different EMR systems are in use in The Netherlands. According to interviewees, all EMR systems presented greater or lesser difficulties when registering a reaction, and EMR systems did not support a clear distinction between a side effect/ intolerance and
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