Quality in Primary Care Open Access

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Successful Implementation of Double blind Placebo controlled Food Challenge for Suspected Cows Milk Protein Allergy in Youth Health Care Experiences from a Municipal Healthcare Service in the Netherlands

Dambacher WM, Dingemanse HS, Vrieze GR & Esther de Vries

Background: The double-blind, placebo-controlled food challenge (DBPCFC) is the preferred diagnostic test for suspected cow’s milk protein allergy (CMA). A national multidisciplinary guideline published in 2012 recommends performing low-risk challenges at a Well-Baby Clinic (WBC) or general practitioner’s (GP) office, instead of in a hospital setting. This article describes our lessons learned during the implementation of low-risk DBPCFCs at WBCs in the ‘s-Hertogenbosch region of the Netherlands. We also describe the results of the first 50 DBPCFCs performed there.

Methods and Findings: Children < 1 year old with suspected CMA in the ‘s-Hertogenbosch region were included in the study. Low-risk children were eligible for DBPCFC at the WBC, high-risk children were referred to the Jeroen Bosch Hospital (JBZ). Organizational aspects during implementation included: funding structure, communication and coordination between professionals, availability of personnel, facilities and resources at the WBC, education of staff members and knowledge transfer to GPs. The first 50 DBPCFCs at the WBC were performed between March 21, 2016 and July 3, 2017. In the same time period, 33 DBPCFCs were performed at the JBZ. The diagnosis of CMA was confirmed in 34% (WBC) to 45% (JBZ) of the children. One child (2%) tested at the WBC experienced an allergic reaction for which medication was needed, compared to 21% of the children tested at the JBZ (p = 0.0058). The savings for health insurance companies add up to €43,510, compared to the old situation where all 83 DBPCFCs would have been performed in a hospital setting.

Conclusion: The current study proves that it is possible, safe and cheaper to perform low-risk DBPCFCs at WBCs instead of hospital settings. Wider implementation can lead to substantial savings in national health care costs. The lessons learned during our study can be used by other Youth Health Care organizations when implementing DBPCFCs.