Patient and Primary Care Physician Perceptions of Penicillin Allergy Testing and Subsequent Use of Penicillin-Containing Antibiotics: A Qualitative Study

Background Removal of an inaccurate penicillin allergy record following testing allows patients to access first-line treatment for infections, and reduce the use of broad-spectrum antibiotics, which contribute to antibiotic resistance. However, it is seldom undertaken. Objectives To identify clinicians' working in primary care and patients' views on barriers and enablers for penicillin allergy testing and subsequent antibiotic use. Methods Fifty interviews with patients and clinicians, including 31 patients with a record of penicillin allergy, 16 with experience of testing, and 19 clinicians. Interviews were analyzed thematically. Results Patients were often unaware of the benefits of penicillin allergy testing and only those patients who had experienced negative consequences of having a penicillin allergy label were motivated to get tested. Clinicians were reluctant to change patient records on the basis of their clinical judgment alone but had limited experience of referring patients with suspected penicillin allergy and were often uncertain about referral criteria and what the testing involved. Clinicians felt that allergy testing could be beneficial and patients who had attended testing reported benefits of the test. Clinicians expressed uncertainty related to whose responsibility it was to make sure that the patient understood allergy test results. Conclusions Clinicians would benefit from information about penicillin allergy testing to be able to use these services appropriately, and to discuss referral with patients. Patients might be more motivated to seek testing if they were more informed regarding its benefits. Good communication between primary and secondary care would facilitate the updating of medical records, and promote better patient education.