A brief educational module for internal medicine residents was associated with improved confidence when counseling patients with food allergies on the use of self-injectable epinephrine, a small study has found.

Self-injectable epinephrine is the first line of defense against anaphylaxis in patients with food allergies. Internal medicine residents seeing this patient population can lack confidence in their ability to accurately counsel patients on how to use an epinephrine auto-injector in a crisis.

To address this, researchers, led by Scott Sicherer, MD, studied the efficacy of a brief educational intervention for internal medicine residents to determine whether it helped improve their ability to manage food allergies, particularly prescribing auto-injectable epinephrine and counseling patients in the proper use of the tools.

Sicherer is the director of the Elliot and Roslyn Jaffe Food Allergy Institute, Serena and John Liew Division of Pediatric Allergy and Immunology, Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City.

The study was published online in JACI Global.

Using pre- and post-intervention surveys, 54 residents were polled on their understanding and comfort level with treating patients with food allergies who needed counseling on the use of self-injectable epinephrine before and after the administration of a brief educational module on the topic.

The surveys asked 22 questions assessing knowledge of food allergy management, types of auto-injector devices, and comfort levels with prescribing and counseling patients on using self-injectable epinephrine.

Participants received an email containing a link to the pre-intervention survey. Upon completion of the survey, participants were directed to a link to view the educational module. The slides included multiple graphics about features of food allergy that could be viewed independently according to the respondent’s own schedule.

After 2 weeks, participants received a follow-up email with a link to the post-intervention survey with the same questions as the initial survey. Participants were able to submit their email for entry into a raffle to win a $50 gift card.

Of the 34 residents who completed both surveys, nearly all reported improvement in their comfort levels for both prescribing and counseling patients on the use of epinephrine auto-injectors (P < .05).

Respondents reported their knowledge about the correct location of epinephrine injection improved from 83% before the education intervention to 97% after the module was completed (P = .02). Respondents also reported their identifying appropriate scenarios for prescribing auto-injection of epinephrine went from 37% to 65% from before to after the intervention (P = .01). In all, 94% of participants rated the intervention as helpful.

After the educational intervention, respondents reported a statistically significant increase in their comfort levels both prescribing auto-injectable epinephrine (P = .0007), which rose from a mean of 4.02 to 5.95, and counseling patients on its use (P < .00001), which increased from 4.13 to 6.08 on a 7-point scale. This trend persisted across all experience levels (postgraduate year 2 through 4). Comfort and familiarity with four common types of auto-injectors also showed significant improvement (P < .00001).

“I certainly believe that the general, or primary care, doctor is the first-line healthcare provider typically to consider the person at risk for anaphylaxis and that ideally they would be familiar with and provide initial advice about preventing a future reaction.” Sicherer told Medscape Medical News. Of course, referral to an allergist for specialized care is part of this as well, he said.

At Lurie Children’s Hospital of Chicago, Chicago, Sai Nimmagadda, MD, said that this kind of educational intervention could be useful across the specialties, not just internal medicine. “Food allergies are increasing tremendously, and so more patients are seeing their primary care doctors for allergies, especially since you can wait a month or more to see an allergist,” Nimmagadda said in an interview with Medscape Medical News. “This is something that especially could be looked at in the pediatric setting. The more you know, the less you fear. It’s important that clinicians know when to prescribe auto-injectors, and how to use them.”

Nimmagadda added that confidence in the physician extends to confidence in patients, without which adverse outcomes are more likely to occur. “You can prescribe the medication, but if you don’t teach them how to use it, then patients will be hesitant to pick it up or use it. You’d be surprised how often a person with food allergies doesn’t use their device,” he said.

Nimmagadda added there is a precedent in asthma treatment. “It’s been shown that the more education in clinicians, the more education the patient also has, and so the more likely they are to use their inhaler.”

Sicherer said that he and his team are making the slides publicly available. “The educational slide set is included with our published study showing its effectiveness and can be downloaded by readers.” The slide set will need to be periodically updated because guidelines and medications change.

Nimmagadda and Sicherer reported having no relevant financial conflicts of interest.