Harmonizing allergy care–integrated care pathways and multidisciplinary approaches

Lydia Daniels, BSc; Sally Barker, BSc; Yoon-Seok Chang, MD, PhD; Tinatin Chikovani, MD, PhD; Audrey DunnGalvin, PhD; Jennifer D. Gerdts, BComm; Roy Gerth Van Wijk, MD, PhD; Trevor Gibbs, MB. ChB, MD; Rosalaura V. Villarreal-Gonzalez, MD; Rosa I. Guzman-Avilan, MD, MHA; Heather Hanna, MSc; Elham Hossny, MD, PhD; Anastasia Kolotilina, MD; José Antonio Ortega Martell, MD; Punchama Pacharn, MD; Cindy E. de Lira Quezada, MD; Elopy Sibanda, MD, PhD; David Stukus, MD; Elizabeth Huiwen Tham, MBBS, MRCPCH; Carina Venter, PhD, RD; Sandra N. Gonzalez-Diaz, MD, PhD; Michael E. Levin, MD, PhD; Bryan Martin, DO; Daniel Munblit, MD, PhD; John O. Warner, MD

World Allergy Organization Journal (Oct 2021)

Harmonizing allergy care–integrated care pathways and multidisciplinary approaches

Lydia Daniels, BSc,
Sally Barker, BSc,
Yoon-Seok Chang, MD, PhD,
Tinatin Chikovani, MD, PhD,
Audrey DunnGalvin, PhD,
Jennifer D. Gerdts, BComm,
Roy Gerth Van Wijk, MD, PhD,
Trevor Gibbs, MB. ChB, MD,
Rosalaura V. Villarreal-Gonzalez, MD,
Rosa I. Guzman-Avilan, MD, MHA,
Heather Hanna, MSc,
Elham Hossny, MD, PhD,
Anastasia Kolotilina, MD,
José Antonio Ortega Martell, MD,
Punchama Pacharn, MD,
Cindy E. de Lira Quezada, MD,
Elopy Sibanda, MD, PhD,
David Stukus, MD,
Elizabeth Huiwen Tham, MBBS, MRCPCH,
Carina Venter, PhD, RD,
Sandra N. Gonzalez-Diaz, MD, PhD,
Michael E. Levin, MD, PhD,
Bryan Martin, DO,
Daniel Munblit, MD, PhD,
John O. Warner, MD

Affiliations

Lydia Daniels, BSc: Faculty of Medicine, Imperial College London, London, UK
Sally Barker, BSc: Faculty of Medicine, Imperial College London, London, UK
Yoon-Seok Chang, MD, PhD: Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
Tinatin Chikovani, MD, PhD: Department of Immunology, Tbilisi State Medical University, Tbilisi, Georgia
Audrey DunnGalvin, PhD: Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
Jennifer D. Gerdts, BComm: Food Allergy Canada, Toronto, ON, Canada
Roy Gerth Van Wijk, MD, PhD: Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
Trevor Gibbs, MB. ChB, MD: Association for Medical Education in Europe (AMEE), Dundee, Scotland, UK; Independant Consultant in Primary Care and Medical Education, UK
Rosalaura V. Villarreal-Gonzalez, MD: Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
Rosa I. Guzman-Avilan, MD, MHA: Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
Heather Hanna, MSc: Imperial College London, London, UK
Elham Hossny, MD, PhD: Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
Anastasia Kolotilina, MD: Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
José Antonio Ortega Martell, MD: Health Sciences Center, Autonomous University of Hidalgo State, Mexico
Punchama Pacharn, MD: Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Cindy E. de Lira Quezada, MD: Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
Elopy Sibanda, MD, PhD: Asthma, Allergy and Immune Dysfunction Clinic, Twin Palms Medical Centre, Harare, Zimbabwe; Department of Pathology, Medical School, National University of Science and Technology, Bulawayo, Zimbabwe
David Stukus, MD: Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
Elizabeth Huiwen Tham, MBBS, MRCPCH: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Carina Venter, PhD, RD: Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Colorado, USA
Sandra N. Gonzalez-Diaz, MD, PhD: Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
Michael E. Levin, MD, PhD: Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
Bryan Martin, DO: Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University, Columbus, OH, USA
Daniel Munblit, MD, PhD: Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK; Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
John O. Warner, MD: Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK; Corresponding author. Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, SW3 6LY, UK.

Journal volume & issue: Vol. 14, no. 10
p. 100584

Abstract

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There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the ''second translational gap''. A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care.We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers.The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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