Developing a behavioural intervention package to identify and amend incorrect penicillin allergy records in UK general practice and subsequently change antibiotic use
,
Sarah Tonkin-Crine,
Robert West,
Sinisa Savic,
Jonathan Sandoe,
Ly-Mee Yu,
Sue Pavitt,
Christopher C Butler,
Marta Wanat,
Bethany Shinkins,
Mina Davoudianfar,
Emily Bongard,
Philip Howard,
Catherine Porter,
Mandy East,
Marta Santillo,
Louise Savic,
Joanne Fielding,
Jenny Boards
Affiliations
4Association of British Neurologists
Sarah Tonkin-Crine
Department of Primary Care Health Sciences, and NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, Oxfordshire, UK
Robert West
1 Department of Behavioural Science and Health, University College London, London, UK
Sinisa Savic
32 Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
Jonathan Sandoe
2 Leeds Teaching Hospitals NHS Trust, Leeds, UK
Ly-Mee Yu
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Sue Pavitt
University of Leeds, Leeds, UK
Christopher C Butler
Nuffield Department of Primary Care Health Sciences, Clinical Trials Unit, University of Oxford, Oxford, UK
Marta Wanat
1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Bethany Shinkins
Warwick Screening & Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
Mina Davoudianfar
Nuffield Department of Primary Care Health Sciences, Clinical Trials Unit, University of Oxford, Oxford, UK
Emily Bongard
Nuffield Department of Primary Care Health Sciences, Clinical Trials Unit, University of Oxford, Oxford, UK
Philip Howard
School of Healthcare, University of Leeds, Leeds, UK
Catherine Porter
Healthcare Associated Infection Group, University of Leeds, Leeds, West Yorkshire, UK
Mandy East
Marta Santillo
Nuffield Department of Primary Care Health Sciences, Clinical Trials Unit, University of Oxford, Oxford, UK
Louise Savic
Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Joanne Fielding
2Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
Jenny Boards
Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
Objectives To develop a behavioural intervention package to support clinicians and patients to amend incorrect penicillin allergy records in general practice. The intervention aimed to: (1) support clinicians to refer patients for penicillin allergy testing (PAT), (2) support patients to attend for PAT and (3) support clinicians and patients to prescribe or consume penicillin, when indicated, following a negative PAT result.Methods Theory-based, evidence-based and person-based approaches were used in the intervention development. We used evidence from a rapid review, two qualitative studies, and expert consultations with the clinical research team to identify the intervention ‘guiding principles’ and develop an intervention plan. Barriers and facilitators to the target behaviours were mapped to behaviour change theory in order to describe the proposed mechanisms of change. In the final stage, think-aloud interviews were conducted to optimise intervention materials.Results The collated evidence showed that the key barriers to referral of patients by clinicians were limited experience of referral and limited knowledge of referral criteria and PAT. Barriers for patients attending PAT were lack of knowledge of the benefits of testing and lack of motivation to get tested. The key barriers to the prescription and consumption of first-line penicillin following a negative test result were patient and clinician beliefs about the accuracy of PAT and whether taking penicillin was safe. Intervention materials were designed and developed to address these barriers.Conclusions We present a novel behavioural intervention package designed to address the multiple barriers to uptake of PAT in general practice by clinicians and patients. The intervention development details how behaviour change techniques have been incorporated to hypothesise how the intervention is likely to work to help amend incorrect penicillin allergy records. The intervention will go on to be tested in a feasibility trial and randomised controlled trial in England.
