Healthcare professionals' experiences of de-labelling erroneous penicillin allergy records in general practice: a qualitative study

Background Penicillin allergy (PenA) prevalence is approximately 6%, but fewer than 10% of these people are expected to be truly allergic. Consequently, a significant proportion of the population are prescribed alternative antibiotics with potential increased risk of acquiring multi-drug resistant bacteria and worse health outcomes. The ALlergy AntiBiotics And Microbial resistAnce (ALABAMA) trial aimed to determine if a penicillin allergy assessment pathway (PAAP) initiated in primary care, is effective in de-labelling erroneous records, improving antibiotic prescribing and patient outcomes. Aim To investigate healthcare professionals’ (HCPs') experiences of the ALABAMA trial. Design & setting Qualitative study using semi-structured interviews in general practice in England. Method Semi-structured interviews were conducted with HCPs (including GPs, research nurses, pharmacists) who delivered the trial. Interviews explored their views about de-labelling incorrect PenA records, their role(s) in the trial, and, where relevant, their experience of prescribing following de-labelling. Results HCPs (n = 18) believed many patients were incorrectly labelled PenA, and were aware of the individual and public health risks this posed. However, GPs explained labels were rarely challenged in general practice because the perceived risks to patients and their professionalism were too great. The PAAP intervention, alongside the ‘protocolisation’ within the ALABAMA trial, was successful at mitigating these risks. Consequently, the trial was well-accepted and commended by HCPs. Conclusion GPs welcomed and accepted the PAAP as a means of correcting erroneous PenA records. There is great potential for PAAP to be supported in primary care if testing becomes more accessible.