Publication:
Harmonizing allergy care–integrated care pathways and multidisciplinary approaches

Issued Date

2021-10-01

Resource Type

Review

ISSN

19394551

DOI

10.1016/j.waojou.2021.100584

Other identifier(s)

2-s2.0-85115922211

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

World Allergy Organization Journal. Vol.14, No.10 (2021)

Suggested Citation

Lydia Daniels, Sally Barker, Yoon Seok Chang, Tinatin Chikovani, Audrey DunnGalvin, Jennifer D. Gerdts, Roy Gerth Van Wijk, Trevor Gibbs, Rosalaura V. Villarreal-Gonzalez, Rosa I. Guzman-Avilan, Heather Hanna, Elham Hossny, Anastasia Kolotilina, José Antonio Ortega Martell, Punchama Pacharn, Cindy E. de Lira Quezada, Elopy Sibanda, David Stukus, Elizabeth Huiwen Tham, Carina Venter, Sandra N. Gonzalez-Diaz, Michael E. Levin, Bryan Martin, Daniel Munblit, John O. Warner Harmonizing allergy care–integrated care pathways and multidisciplinary approaches. World Allergy Organization Journal. Vol.14, No.10 (2021). doi:10.1016/j.waojou.2021.100584 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77217

Research Projects

Organizational Units

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Journal Issue

Thesis

Title

Harmonizing allergy care–integrated care pathways and multidisciplinary approaches

Author(s)

Lydia Daniels
 Sally Barker
 Yoon Seok Chang
 Tinatin Chikovani
 Audrey DunnGalvin
 Jennifer D. Gerdts
 Roy Gerth Van Wijk
 Trevor Gibbs
 Rosalaura V. Villarreal-Gonzalez
 Rosa I. Guzman-Avilan
 Heather Hanna
 Elham Hossny
 Anastasia Kolotilina
 José Antonio Ortega Martell
 Punchama Pacharn
 Cindy E. de Lira Quezada
 Elopy Sibanda
 David Stukus
 Elizabeth Huiwen Tham
 Carina Venter
 Sandra N. Gonzalez-Diaz
 Michael E. Levin
 Bryan Martin
 Daniel Munblit
 John O. Warner

Other Contributor(s)

Siriraj Hospital
 Seoul National University Bundang Hospital
 Nationwide Children’s Hospital
 Tbilisi State Medical University
 National University of Science and Technology Bulawayo
 Erasmus MC
 National University Hospital
 University of Colorado School of Medicine
 Universidad Autónoma del Estado de Hidalgo
 NUS Yong Loo Lin School of Medicine
 University College Cork
 Imperial College Faculty of Medicine
 Hospital Universitario Dr. Jose Eleuterio Gonzalez
 Ain Shams University
 Imperial College London
 National Heart and Lung Institute
 Sechenov First Moscow State Medical University
 The Ohio State University
 University of Cape Town
 Independant Consultant in Primary Care and Medical Education
 Moscow Research and Clinical Center for Neuropsychiatry
 Food Allergy Canada
 Asthma
 Association for Medical Education in Europe (AMEE)

Abstract

There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the "second translational gap". A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care. We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers. The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.

Keyword(s)

Immunology and Microbiology
 Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/77217

Collections

Scopus 2021