AN EMR INTERVENTION TO IMPROVE EARLY INTRODUCTION OF PEANUTS IN INFANTS AT COMMUNITY-BASED HEALTH CLINICS

Abstract

<h3>Introduction</h3> Infant peanut introduction is a recommended childhood feeding practice, following the landmark LEAP study showing that early introduction of peanut dramatically reduced rates of peanut allergy in high-risk infants. However, counselling about early introduction at infant well visits may not be happening systematically in all primary care settings. <h3>Methods</h3> In April 2019, we introduced an EMR screening tool in our general pediatrics clinics to discuss peanut allergy risk factors and early peanut introduction at well visits between 4-11 months. A retrospective chart review was undertaken, comparing all infants seen for 4-11 month old well visits in the year following the intervention (April 2019-March 2020) versus the year prior to the intervention (April 2018-March 2019). <h3>Results</h3> A total of 379 charts were screened, 179 pre-intervention and 200 post-intervention. There were no statistically significant differences in baseline characteristics in the pre-intervention and post-intervention groups, including age, sex, and comorbid egg allergy and eczema. Post-intervention, there was a statistically significant increase in discussion of early peanut introduction. 7 infants were screened pre-intervention, while 56 were screened after (p<0.001). There was a statistically significant increase in documentation of peanut in the diet by 12 months, with 5 documented pre-intervention and 23 post-intervention (p=0.001). <h3>Conclusion</h3> While introduction of the EMR screening tool increased discussion of early peanut introduction in community-based clinics, most infants still didn't have documentation of counselling on early peanut introduction in their medical records. Further interventions to improve rates of early peanut introduction are necessary to minimize development of peanut allergy.