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Analysis of the Long-Term Outcomes of β -Lactam Allergies with Recommendations for Improving Erroneous β -Lactam Allergy Management using Mixed Methods

Gray, Matthew P (2023) Analysis of the Long-Term Outcomes of β -Lactam Allergies with Recommendations for Improving Erroneous β -Lactam Allergy Management using Mixed Methods. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Allergies to β-Lactam (BL) antimicrobials are the most commonly reported medication allergy. Patients with documented BL allergies are more likely to receive second or third-line antimicrobials and incur clinical detriment through BL avoidance, including higher rates of resistant infections and higher healthcare utilization. Most BL allergies are reported in error, and many patients with documented BL allergies can tolerate BL products. There has been an increase in understanding of the outcomes associated with BL allergies and methods for erroneous BL allergy delabeling, but gaps in the literature remain that may be hindering efforts to reduce the harm caused by erroneous BL allergies. The findings of this dissertation address critical gaps in literature by using a mixed methods approach to improve the understanding of BL evaluation processes and long-term clinical outcomes.
The first study used a qualitative study design to interview front-line clinicians on their perspectives and attitudes when evaluating the legitimacy of BL allergies. Through inductive and deductive analysis, interventions targeted at technology improvements and expanding the role of pharmacists in BL allergy evaluation were recommended. The second study used a retrospective cohort study design and clustered longitudinal analysis to examine the long-term outcomes patients with BL allergies. Over 12 years of follow-up, patients with BL allergies experienced significantly higher rates of resistant infections and supports delabeling efforts by displaying substantial long-term detriment associated with BL allergy labeling. The third study used natural-language processing to develop a pipeline to identify clinical note segments indicating instances where patients have previously tolerated BL products to promote the usage of these previously-tolerated products despite documented allergies that can be used as a proof-of-concept for implementation by health systems. A survey indicated that confidence in using BL products increased when presented with information indicating previous BL tolerance.
The findings of this dissertation address critical gaps in the understanding of BL allergies and produce a tool to improve future allergy evaluation efforts. Implementation of tools to improve allergy documentation and enable informed allergy evaluation may empower clinicians to reduce the rate of erroneously documented BL allergies and improve the use of first-line BL antimicrobials.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Gray, Matthew Pmpg30@pitt.edumpg30
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairKane-Gill,
Committee MemberKirisci,
Committee MemberKellum,
Committee MemberBoyce,
Date: 11 August 2023
Date Type: Publication
Defense Date: 7 April 2023
Approval Date: 11 August 2023
Submission Date: 9 August 2023
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 277
Institution: University of Pittsburgh
Schools and Programs: School of Pharmacy > Pharmaceutical Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Penicillin Allergy; Dissertation; Outcomes Research
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