A Survey on Knowledge Gaps in Assessment and Management of Severe Drug Hypersensitivity Reactions: Multicenter Cross‐Sectional Study of Australian Health Care Providers

Abstract

Severe drug hypersensitivity reactions (DHRs) are often encountered by health care professionals (HCPs). We evaluated knowledge of doctors and pharmacists in the assessment and management of severe DHRs using a structured questionnaire. A cross-sectional study was conducted in 4 metropolitan hospital networks in Melbourne, Australia. A 13-question, scenario-based multiple-choice questionnaire to assess specific knowledge domains in drug hypersensitivity syndrome recognition, causality attribution, cross-reactivity patterns, appropriate diagnostic tests, and therapy was administered to HCPs of various vocation and specialty groups.Data were analyzed according to profession,self-reported experience,and preparedness in managing severe DHRs. Two hundred thirty-eight participants (45.0% senior doctors, 24.4% junior doctors, and 30.7% pharmacists) across a range of subspecialties achieved an overall median score of 7 (IQR, 5-8)-overall 55.6% correct responses to all questions-with senior doctors outperforming junior doctors and pharmacists (P < .001). The best performance by all participants was in DHR syndrome recognition (60.9%), and the poorest was in diagnostics/therapy (52.0%). HCP group and experience level were significantly associated with better performance in the knowledge domains of cross-reactivity and diagnostics/therapy (P = .003 and < .001, respectively), but not in the domains of syndrome recognition and causality attribution (P > .05). Levels of self-reported preparedness in DHR management were not associated with performance rates in any of the knowledge domains. This study demonstrated significant knowledge gaps in the recognition and management of severe drug hypersensitivity reactions. Targeted multidisciplinary education of staff caring for these patients is needed to improve knowledge gaps.

Adverse drug reaction management in hospital settings: review on practice variations, quality indicators and education focus

“…Many studies have examined the reasons behind underreporting, yet few studies have evaluated variations in the quality of ADR reports, and risk communication. The latter two factors are more likely influenced by HCPs' knowledge and skills [48]. Thus, overall clinical competency may significantly contribute to variations in management observed [49].…”

“…In the same survey, over 95% believed pharmacovigilance teaching should be included in the undergraduate pharmacy curriculum and almost 90% believed that professional bodies should include this topic in postgraduate professional development activities [57]. Specifically on the knowledge regarding drug hypersensitivity reactions (DHRs), an Australian multicentre study amongst 238 medical doctors and pharmacists surveyed in hospital settings found significant knowledge gaps in the domains of syndromic recognition, causality attribution, antibiotic cross-reactivity patterns and diagnostics/therapy, corresponding to an overall correct score of just 55.6% [48]. Knowledge gaps were similar for key ADR principles assessed, regardless of healthcare profession and seniority level [48].…”

“…Specifically on the knowledge regarding drug hypersensitivity reactions (DHRs), an Australian multicentre study amongst 238 medical doctors and pharmacists surveyed in hospital settings found significant knowledge gaps in the domains of syndromic recognition, causality attribution, antibiotic cross-reactivity patterns and diagnostics/therapy, corresponding to an overall correct score of just 55.6% [48]. Knowledge gaps were similar for key ADR principles assessed, regardless of healthcare profession and seniority level [48]. A lack of medication allergy knowledge in undergraduate medical training was noted in a study from Turkey, which found only 58.5% of questions regarding medication allergy were answered correctly [58].…”

A Continuing Education Activity Durably Addressed Knowledge Gaps Related to Penicillin Allergies Among Pharmacists and Pharmacy Technicians

“…Recent literature suggests that physicians and pharmacists possess significant knowledge gaps related to the management of antibiotic allergies. 14-16 De Clercq et al assessed family physicians and pharmacists and found that participants believed they had insufficient knowledge about antibiotic allergies, and many were unaware of negative health consequences associated with antibiotic allergies. 14 A survey on inpatient practitioners by Staicu et al found that the majority of respondents reported spending less than 2 minutes assessing patients’ allergy histories.…”

“…15 Mazzoni et al assessed providers on knowledge related to drug hypersensitivity, with only 55.6% providing correct responses. 16…”