A survey of caregiver perspectives on emergency epinephrine autoinjector sharing

Shaker, Marcus; Kanaoka, Tsuzumi; Murray, R. G.; Toy, Dana; Shaker, Susan; Drew, Aurora

doi:10.1016/j.jaip.2018.02.017

Cited by 12 publications

(12 citation statements)

References 8 publications

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“…Comparison with the recent study by Shaker et al [42] is very instructive, given the fact that it also targeted parents of allergic children. The research question of Shaker et al was about sharing an AAI, and our research question was about joining an ERC, making our works complementary.…”

Section: Discussionmentioning

confidence: 91%

“…From a giving point of view, age is positively correlated with volunteerism [66] and is also positively correlated with the ability to help another patient in an emergency, such as to provide him with cardiopulmonary resuscitation [69]. The negative correlation between a history of anaphylactic attacks in the past and parents’ willingness to enroll their children can be explained by the parents’ concerns that children who use their AAI to help another patient will remain unprotected until they get a replacement [42].…”

Section: Discussionmentioning

confidence: 99%

“…It is therefore noteworthy that according to the EPIMADA protocol, an ambulance arriving on scene is required to provide a replacement AAI to the community member who responded to the emergency by giving his own AAI to the patient in distress. In other words, the EPIMADA protocol should alleviate the concerns identified by Shaker et al [42].…”

Section: Discussionmentioning

confidence: 99%

“…EPIMADA is a regulated community, and in every event, the volunteers are provided with guidance by phone from experienced EMS dispatchers. This approach can thus alleviate concerns about “harming the patient if it is not a real allergic reaction” that were also identified by Shaker et al [42].…”

Section: Discussionmentioning

confidence: 99%

“…A recent survey on automatic adrenaline injector (AAI) sharing shows that 76.6% of AAI carriers expressed willingness to share their AAI right away. Respondents who would not share their AAI were concerned about the potential harm to the patient (eg, misdiagnosis or overdose) and to their child (eg, having no medication left or delay in obtaining a refill) [42]. Joining an ERC indicates readiness to share a personal prescription medication with a stranger.…”

Section: Introductionmentioning

confidence: 99%

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Childrens' and Parents' Willingness to Join a Smartphone-Based Emergency Response Community for Anaphylaxis: Survey

Khalemsky¹,

Schwartz²,

Silberg³

et al. 2019

JMIR Mhealth Uhealth

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Background Medical emergencies such as anaphylaxis may require immediate use of emergency medication. Because of the low adherence of chronic patients (ie, carrying anti-anaphylactic medication) and the potentially long response time of emergency medical services (EMSs), alternative approaches to provide immediate first aid are required. A smartphone-based emergency response community (ERC) was established for patients with allergies to enable members to share their automatic adrenaline injector (AAI) with other patients who do not have their AAI at the onset of anaphylactic symptoms. The community is operated by a national EMS. In the first stage of the trial, children with food allergies and their parents were invited to join. Objective This study aimed to identify the factors that influence the willingness to join an ERC for a group of patients at risk of anaphylaxis. Methods The willingness to join an ERC was studied from different perspectives: the willingness of children with severe allergies to join an ERC, the willingness of their parents to join an ERC, the willingness of parents to enroll their children in an ERC, and the opinions of parents and children about the minimum age to join an ERC. Several types of independent variables were used: demographics, medical data, adherence, parenting style, and children's autonomy. A convenience sample of children and their parents who attended an annual meeting of a nonprofit organization for patients with food allergies was used. Results A total of 96 questionnaires, 73 by parents and 23 by children, were collected. Response rates were approximately 95%. Adherence was high: 22 out of 23 children (96%) and 22 out of 52 parents (42%) had their AAI when asked. Willingness to join the community was high among parents (95%) and among children (78%). Willingness of parents to enroll their children was 49% (36/73). The minimum age to join an ERC was 12.27 years (SD 3.02) in the parents’ opinion and 13.15 years (SD 3.44) in the children’s opinion. Conclusions Parents’ willingness to join an ERC was negatively correlated with parents’ age, child’s age, and parents’ adherence. This can be explained by the free-rider effect: parents who carried an AAI for their young child, but had low adherence, wanted to join the ERC to get an additional layer of emergency response. Children’s willingness to join the community was positively correlated with age and negatively correlated with the child’s emotional autonomy. Parents’ willingness to enroll their children in an ERC was positively correlated with child’s age and negatively correlated with parents’ adherence: again, this can be explained by the aforementioned free-rider effect. Parents’ and children’s opinions about the minimum age to join an ERC were negatively correlated with protective parenting style and positively correlated with monitoring parenting style.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Childrens' and Parents' Willingness to Join a Smartphone-Based Emergency Response Community for Anaphylaxis: Survey

Khalemsky¹,

Schwartz²,

Silberg³

et al. 2019

JMIR Mhealth Uhealth

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Analysis of Value-Based Costs of Undesignated School Stock Epinephrine Policies for Peanut Anaphylaxis

Shaker

Greenhawt

2019

JAMA Pediatr

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IMPORTANCEChildren experiencing anaphylaxis at school may lack access to a personal epinephrine device, prompting recent legislation permitting undesignated (eg, non-student specific) stock epinephrine autoinjector units at school. However, epinephrine device costs vary, and the cost-effectiveness of undesignated school stock epinephrine is uncharacterized to date. OBJECTIVE To define value-based strategies for undesignated school stock epinephrine programs. DESIGN, SETTING, AND PARTICIPANTS Markov simulations of the Chicago Public Schools system were used over extended time horizons to model 2 school stock epinephrine autoinjector policies to provide access for at-risk students. The dates of the data used in the analysis were school year). MAIN OUTCOMES AND MEASURESThis study compared the following 3 strategies: no school undesignated epinephrine supply, school undesignated supplemental epinephrine supply (supplemental model), and school undesignated universal epinephrine supply (universal model). The base-case model assumed a 10-fold reduced fatality risk with having undesignated stock epinephrine units available vs not having undesignated stock epinephrine units available. Costs of school stock epinephrine units available for acquisition by schools were evaluated from a societal perspective. Quality-adjusted life-years (QALYs) and total epinephrine acquisition expenses were calculated. RESULTSBased on Markov simulations of the Chicago Public Schools system (371 382 students), the cost was $107 816 (95% CI, $107 382-$108 250) for no school undesignated epinephrine supply compared with $108 160 (95% CI, $107 725-$108 595) for the supplemental model and $100 397 (95% CI, $99 979-$100 815) for the universal model. Undesignated stock epinephrine improved outcomes, with 26.869 (95% CI, QALYs accrued as the model concluded compared with 26.867 (95% CI, 26.839-26.896) QALYs for the strategy without undesignated stock epinephrine. When comparing supplemental model stock epinephrine to the strategy without undesignated devices, the incremental cost-effectiveness ratio was high at $268 811 per QALY in the base-case simulation. However, the cost of the supplemental model fell below $100 000 per QALY when the annual undesignated epinephrine acquisition costs did not exceed $338 per school (compared with stock epinephrine unavailability). The universal model dominated all others and was associated with significant cost savings ($7419 per student at risk who would otherwise be prescribed an individual school epinephrine supply).CONCLUSIONS AND RELEVANCE Undesignated school stock epinephrine is cost-effective at device acquisition costs not exceeding $338 per school per year, although a universal model vs a supplemental model is associated with superior health and economic outcomes.

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Implantable device with magnetically rotating disk for needle‐free administrations of emergency drug

Kim

Han

Kim

et al. 2023

Bioengineering & Transla Med

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Prompt administration of first‐aid drugs can save lives during medical emergencies such as anaphylaxis and hypoglycemia. However, this is often performed by needle self‐injection, which is not easy for patients under emergency conditions. Therefore, we propose an implantable device capable of on‐demand administration of first‐aid drugs (i.e., the implantable device with a magnetically rotating disk [iMRD]), such as epinephrine and glucagon, via a noninvasive simple application of the magnet from the outside skin (i.e., the external magnet). The iMRD contained a disk embedded with a magnet, as well as multiple drug reservoirs that were sealed with a membrane, which was designed to rotate at a precise angle only when the external magnet was applied. During this rotation, the membrane on a designated single‐drug reservoir was aligned and torn to expose the drug to the outside. When implanted in living animals, the iMRD, actuated by an external magnet, delivers epinephrine and glucagon, similar to conventional subcutaneous needle injections.

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A survey of caregiver perspectives on emergency epinephrine autoinjector sharing

Cited by 12 publications

References 8 publications

Childrens' and Parents' Willingness to Join a Smartphone-Based Emergency Response Community for Anaphylaxis: Survey

Childrens' and Parents' Willingness to Join a Smartphone-Based Emergency Response Community for Anaphylaxis: Survey

Analysis of Value-Based Costs of Undesignated School Stock Epinephrine Policies for Peanut Anaphylaxis

Implantable device with magnetically rotating disk for needle‐free administrations of emergency drug

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