Kate Johnson

November 14, 2014

ATLANTA — A training module on the use of an epinephrine autoinjector could help improve the skills of many healthcare providers, according to new research.

"This important deficiency in provider training is modifiable, but there is very limited published information on validated or effective interventions in this area," said senior investigator Artemio Jongco III, MD, from the Hofstra North Shore–LIJ School of Medicine in Great Neck, New York.

"Unfortunately, there is a rich and extensive literature showing that medical providers, including physicians, regardless of stage of training, under-recognize and undertreat anaphylaxis," he said here at the American College of Allergy, Asthma & Immunology 2014.

"Residents in our own health system lacked familiarity and experience with anaphylaxis diagnosis and management, including how to use epinephrine autoinjectors," Dr Jongco told Medscape Medical News.

Being "a low-frequency, but high-consequence medical condition," anaphylaxis is "challenging to teach about and train for because it occurs so rarely that most physicians are unlikely to get ample opportunity to learn about and manage it," he explained.

Low-Frequency, High-Consequence Problem

The study involved 58 interns in internal medicine who were just beginning their residency program.

The interns completed a 15-minute EpiPen training module developed by the researchers. It involved watching a segment of the manufacturer's instructional video, a recap and question period with an allergist, and hands-on practice with needleless EpiPen trainers.

They were then evaluated by two independent scorers — an allergist and a senior resident with allergy training — using the EpiPen proficiency assessment tool (E-PAT), a nine-step checklist also developed by Dr Jongco's team.

After the training, mean score on the 8-point E-PAT was 7.5, suggesting that the module was effective, reported Dr Jongco. Inter-rater reliability for each item on the E-PAT was high (P < .0001).

Before the training, 93% of the interns had never used an EpiPen, 0% had used one in the previous year, and 26% had never used an EpiPen trainer. Despite this, 63% reported having a family member, friend, or colleague who usually carries an EpiPen.

A similar lack of clinician education has been found in Europe, "starting from the medical students and including emergency physicians," said Antonella Muraro, MD, president-elect of the European Academy of Allergy and Clinical Immunology (EAACI) and lead author of the EAACI position paper on anaphylaxis guidelines for healthcare providers (Allergy. 2014;69:1026-1045).

For this reason, she told Medscape Medical News, "we have started courses for general pediatricians and general practitioners who are dealing with patients on the frontline, and for emergency physicians, instructing them how to use the self-injectable device."

American College of Allergy, Asthma & Immunology (ACAAI) 2014: Abstract 273. Presented November 8, 2014.

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