Effect of educational and electronic medical record interventions on food allergy management

Zelig, Ari; Harwayne‐Gidansky, Ilana; Gault, Allison; Wang, Julie

doi:10.2500/aap.2016.37.3970

Cited by 9 publications

(8 citation statements)

References 11 publications

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“…BPAs are commonly used for electronic CDS in primary care [12][13][14]. However, the impact of BPAs on ACEI and ARB prescribing for patients with diabetes and elevated blood pressures has not been reported [3].…”

Section: Comparison With Previous Workmentioning

confidence: 99%

“…Previous studies have evaluated the impact of BPAs using pre-post study designs, but with no comparison group [12][13][14]. Some have observed increased compliance with clinical practice guidelines after the implementation of a BPA [12,13], whereas others have observed no significant changes [14]. We are not aware of previous research having comprehensively examined the impact of a BPA using a more rigorous quasi-experimental difference-in-differences design or the impact of a BPA on diabetes care.…”

Section: Introductionmentioning

confidence: 98%

“…In particular, there is an opportunity to study the impact of readily available CDS tools within EHR systems, such as the Best Practice Advisory (BPA) within the Epic EHR system (Epic Systems Corporation, Verona, WI), to prompt PCPs when there is an indication to start a patient with diabetes on an ACEI or ARB. Previous studies have evaluated the impact of BPAs using pre-post study designs, but with no comparison group [12][13][14]. Some have observed increased compliance with clinical practice guidelines after the implementation of a BPA [12,13], whereas others have observed no significant changes [14].…”

Section: Introductionmentioning

confidence: 99%

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Impact of a “Chart Closure” Hard Stop Alert on Prescribing for Elevated Blood Pressures Among Patients With Diabetes: Quasi-Experimental Study

et al. 2020

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Background University of California at Los Angeles Health implemented a Best Practice Advisory (BPA) alert for the initiation of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) for individuals with diabetes. The BPA alert was configured with a “chart closure” hard stop, which demanded a response before closing the chart. Objective The aim of the study was to evaluate whether the implementation of the BPA was associated with changes in ACEI and ARB prescribing during primary care encounters for patients with diabetes. Methods We defined ACEI and ARB prescribing opportunities as primary care encounters in which the patient had a diabetes diagnosis, elevated blood pressure in recent encounters, no active ACEI or ARB prescription, and no contraindications. We used a multivariate logistic regression model to compare the change in the probability of an ACEI or ARB prescription during opportunity encounters before and after BPA implementation in primary care sites that did (n=30) and did not (n=31) implement the BPA. In an additional subgroup analysis, we compared ACEI and ARB prescribing in BPA implementation sites that had also implemented a pharmacist-led medication management program. Results We identified a total of 2438 opportunity encounters across 61 primary care sites. The predicted probability of an ACEI or ARB prescription increased significantly from 11.46% to 22.17% during opportunity encounters in BPA implementation sites after BPA implementation. However, in the subgroup analysis, we only observed a significant improvement in ACEI and ARB prescribing in BPA implementation sites that had also implemented the pharmacist-led program. Overall, the change in the predicted probability of an ACEI or ARB prescription from before to after BPA implementation was significantly greater in BPA implementation sites compared with nonimplementation sites (difference-in-differences of 11.82; P<.001). Conclusions A BPA with a “chart closure” hard stop is a promising tool for the treatment of patients with comorbid diabetes and hypertension with an ACEI or ARB, especially when implemented within the context of team-based care, wherein clinical pharmacists support the work of primary care providers.

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Section: Comparison With Previous Workmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of a “Chart Closure” Hard Stop Alert on Prescribing for Elevated Blood Pressures Among Patients With Diabetes: Quasi-Experimental Study

et al. 2020

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“…. Descriptive characteristics of demographic variables.....................................................33 (Zelig, Harwayne-Gidansky, Gault, & Wang, 2016). There has been a dramatic increase in both the prevalence and the severity of pediatric FAs in recent decades, with the Center for Disease Control (CDC) reporting an estimated 50% increase between 1997 and 2011 (Branum & Lukacs, 2008).…”

Section: List Of Tablesmentioning

confidence: 99%

Examining Differences in Parent Knowledge About Pediatric Food Allergies

Luke

Flessner

2019

Journal of Pediatric Psychology

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Objective Pediatric food allergy (FA) is a serious health condition that has become increasingly prevalent. Parents often play a primary role in assessing and managing risk for their child’s FAs, making it critical that they remain informed of the most recent guidelines for FA management. This study aimed to examine if diagnostic source (i.e., pediatrician vs. allergist) and child- and parent-level variables predicted parental FA knowledge using a comprehensive measure. Methods The Food Allergy Knowledge Test (FAKT) was administered to parents (N = 518) of children aged 3–17 years with (n = 349) and without (n = 169; i.e., control group) FAs using internet-sampling procedures. The sample was further partitioned into parents of children diagnosed by an allergist or a pediatrician, and control group parents who did or did not endorse knowing someone with an FA. Results Significant group differences were found with respect to the overall FAKT score and diagnostic source. Among the FA group, parental relationship to child, income, identification with a minority status, parental anxiety, and child possession of an emergency action plan were significant predictors of FAKT scores. Conclusions Knowledge of FA was poor across all groups. Education for caregivers both with and without food-allergic children is important to ensure FA safety in multiple settings. Future directions and limitations are discussed.

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“…Finally, addressing the utility of the electronic medical record in allergy/immunology practice, 28 Zelig et al 29 sought to improve physician knowledge and management of food allergies by implementing educational and electronic medical record interventions. Their report disappointingly demonstrated that neither intervention resulted in improved management of children with food allergies.…”

mentioning

confidence: 99%