126 Chapter 5 of side effects and antibiotic allergic reactions is needed to gain more insight into this particular determinant. These findings might then be used to design and implement patient-directed interventions. In this study, unawareness of the problem of incorrect antibiotic allergy registration and its consequences was an issue in all healthcare domains, especially in primary care. While most PCPs were unaware of the problem of incorrect registration of allergies, ECPs by contrast regularly encountered patients with multiple antibiotic allergy registrations, severely hindering the prescription of the correct antibiotic. Multiple antibiotic allergy registrations are most likely the result of lifelong collection of registrations. The lack of awareness is concordant with earlier reports in primary and hospital care and suggests that greater awareness is needed to change the behaviour of healthcare providers (6, 7, 20). In a study by Schouten et al., improved awareness played a key role in removing barriers to optimal antibiotic therapy in a hospital setting (21). Interventions to improve antibiotic allergy registrations should therefore focus not only on improving knowledge but also on increasing awareness. Another important perceived determinant was the failure of EMR software to support the quick and accurate registration of symptoms and their time-course. EMR software developers need to simplify registration and allow a distinction between allergy or side effect (17). Some interviewees suggested development of a guideline accompanied by a clinical decision making system in the EMR. A study by Blumenthal et al. showed that this type of system can indeed improve the registration of antibiotic allergies in a hospital setting (22). Most incorrect antibiotic allergy registrations can be safely removed with a thorough history with or without a provocation test (23). In most cases skin testing is not needed. Guidelines on the clinical approach of a potential antibiotic allergy and removing of incorrect antibiotic allergies are highly needed. To a greater or lesser extent, domains mostly shared the same determinants. This supports the development of interventions that transcend the individual healthcare domains. For example, educational programs may be developed targeting all domains, with the aim to improve knowledge, but also interdisciplinary communication and collaboration. Furthermore, ICT registration and decision tools could be developed to support both primary care and hospital care.
RkJQdWJsaXNoZXIy MTk4NDMw