title: Allergen immunotherapy at university health services and allergist's reasons for guidelines nonadherence.
abstract: BACKGROUND
  Our previous pilot study conducted at the University of Michigan Health Services showed that fewer than 25% of the non-university allergen immunotherapy (AIT) prescribers adhered to AIT labeling guidelines which impacted both patients and healthcare personnel involved in AIT administration.
  
  
  OBJECTIVE
  We expand our study to characterize AIT labeling compliance and impact of practice variability at the "Big 10" University Health Services, and investigate prescribers motives for nonadherence to practice parameter guidelines.
  
  
  METHODS
  Three online surveys were distributed: AIT Administrator and Manager surveys for healthcare personnel at the "Big 10"; University Health Services and Physician Survey for physician members of the AAAAI. Data were analyzed using frequency/bivariate analysis and logistic regression.
  
  
  RESULTS
  21 AIT administrators from 10 University Health Services responded. 90.4% (20/21) felt labels containing all recommended practice parameter guidelines, components would decrease error; and standardization of labels, buildup and missed dose schedules would increase workflow efficiency (76%; 16/21). 90% (17/19) felt standardized protocols for treatment of systemic reactions would increase patient safety, workflow efficiency and comfort level of administrators. Only 28.6% of AIT extract vial labels at University Health Services were in accordance with practice parameter guidelines. Despite familiarity with the guidelines (91.5%; 697/762), only 64% (488/762) of surveyed physicians had practice parameter adherent AIT extracts labels with higher odds of a complete label when physicians were in group practice (odds ratio 1.51; [95% confidence interval, 1.06-2.15]; P=0.02). Reasons for nonadherence included having personalized labeling systems (55.4%, 174/314), unfamiliarity (14%, 44/314) and disagreement (9%, 29/314) with practice parameter guidelines.
  
  
  CONCLUSIONS
  Poor adherence with AIT practice parameters labeling guidelines is an important concern in nonallergy offices. It is imperative that allergists comply with the highest recommended standards to provide the best clinical outcomes and ensure excellent and efficient care in both allergy and non-allergy offices.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Karam
authors.forename: Christine
authors.initials: C
authors.lastname: Holland
authors.forename: Zi
authors.initials: Z
authors.lastname: Yang
authors.forename: Kiela
authors.initials: K
authors.lastname: Samuels
authors.forename: Georgiana
authors.initials: G
authors.lastname: Sanders
mesh_terms: D000072223:Allergists / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003888:Desensitization, Immunologic / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013333:Student Health Services; D011795:Surveys and Questionnaires; D057188:Workflow