{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:53:08Z","timestamp":1789487588978,"version":"build-2803163510"},"reference-count":58,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Patients with unconfirmed and potentially false penicillin allergy labels receive unnecessarily broad-spectrum antibiotics that can lead to worse health outcomes and antimicrobial resistance. While ambulatory care is a favorable setting to engage in penicillin allergy delabeling, the process of removing an incorrect penicillin allergy label has not been widely implemented.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To contextualize barriers to and facilitators of penicillin allergy delabeling from a diverse range of perspectives and inform actionable strategies.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This qualitative study used in-depth interviews and focus groups with patients who had a penicillin allergy label, clinicians, and other stakeholders from primary care clinics in 3 hospital networks in Boston, Massachusetts. Participants were recruited from March 1 through September 30, 2024.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n The primary outcome was participant-perceived factors influencing engagement in discussions about penicillin allergy delabeling. The analytic approach was informed by the updated Consolidated Framework for Implementation Research (CFIR), with a mixed inductive-deductive analysis that incorporated the CFIR Expert Recommendations for Implementing Change (ERIC) implementation strategy matching tool to map interview data to implementation strategies.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study included 119 participants (84 [71%] female), of whom 69 (58%) were patients and 50 (42%) were clinicians and stakeholders; 87 (73%) participated in interviews and 32 (27%) participated in focus groups. Six barriers to penicillin allergy delabeling emerged: (1) clinician avoidance of conversations about penicillin allergy labels, (2) patients not being asked about their penicillin allergy labels, (3) language barriers, (4) time constraints, (5) perceived elevated risk of removing a penicillin allergy, and (6) limited access to allergists. These barriers aligned with 5 ERIC strategies: (1) create new ways of delivering care, (2) identify champions, (3) use data experts, (4) alter incentive structures, and (5) conduct educational meetings.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This qualitative study guided by implementation science identified strategies to overcome barriers to penicillin allergy delabeling. These strategies may inform the next steps for implementation science research to improve access to penicillin allergy testing and delabeling.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.33825","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:00:20Z","timestamp":1789484420000},"page":"e2633825","source":"Crossref","is-referenced-by-count":0,"title":["Strategies to Increase Equitable Access to Penicillin Allergy Delabeling Interactions"],"prefix":"10.1001","volume":"9","author":[{"given":"Alysse","family":"Wurcel","sequence":"first","affiliation":[{"name":"Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts"},{"name":"Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts"},{"name":"Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Crabtree","sequence":"additional","affiliation":[{"name":"Division of Allergy and Clinical Immunology, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olabimpe","family":"Asupoto","sequence":"additional","affiliation":[{"name":"Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madelyn","family":"Eippert","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Allergy and Sleep, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvane","family":"Ngassa","sequence":"additional","affiliation":[{"name":"Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Tam","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts"},{"name":"Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Kohut","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Primary Care, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kap Sum","family":"Foong","sequence":"additional","affiliation":[{"name":"Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Stone","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Primary Care, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Daudelin","sequence":"additional","affiliation":[{"name":"Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts"},{"name":"Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Bartels","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"},{"name":"The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly G.","family":"Blumenthal","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Allergy and Sleep, Mayo Clinic, Jacksonville, Florida"},{"name":"The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"2","key":"zoi260921r2","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1001\/jama.2018.19283","article-title":"Evaluation and management of penicillin allergy: a review.","volume":"321","author":"Shenoy","year":"2019","journal-title":"JAMA"},{"issue":"6","key":"zoi260921r3","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1016\/j.jaci.2022.08.028","article-title":"Drug allergy: a 2022 practice parameter update.","volume":"150","author":"Khan","year":"2022","journal-title":"J Allergy Clin Immunol"},{"issue":"11","key":"zoi260921r4","doi-asserted-by":"publisher","first-page":"704","DOI":"10.12788\/jhm.3170","article-title":"Things we do for no reason: failing to question a penicillin allergy history.","volume":"14","author":"Kleris","year":"2019","journal-title":"J Hosp Med"},{"issue":"3","key":"zoi260921r6","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.anai.2020.06.010","article-title":"Risk of physician burnout in the North American allergist-immunologist workforce: a report from the American College of Allergy, Asthma and Immunology Physician Wellness Taskforce.","volume":"125","author":"Marshall","year":"2020","journal-title":"Ann Allergy Asthma Immunol"},{"issue":"5","key":"zoi260921r7","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.anai.2021.06.008","article-title":"Allergy and immunology physician workforce: where do we stand today?","volume":"127","author":"Malick","year":"2021","journal-title":"Ann Allergy Asthma Immunol"},{"issue":"4","key":"zoi260921r8","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/j.jaip.2014.02.003","article-title":"Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers\u2019 antibiotic prescribing knowledge.","volume":"2","author":"Blumenthal","year":"2014","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"2","key":"zoi260921r9","doi-asserted-by":"publisher","first-page":"AB123","DOI":"10.1016\/j.jaci.2020.12.453","article-title":"Identifying and overcoming barriers to inpatient penicillin allergy de-labeling by non-allergists.","volume":"147","author":"Rozario","year":"2021","journal-title":"J Allergy Clin Immunol"},{"issue":"1","key":"zoi260921r10","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s13223-023-00842-y","article-title":"Barriers to penicillin allergy de-labeling in the inpatient and outpatient settings: a qualitative study.","volume":"19","author":"Alagoz","year":"2023","journal-title":"Allergy Asthma Clin Immunol"},{"issue":"5","key":"zoi260921r11","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.ajic.2017.12.016","article-title":"Exploring the nurses\u2019 role in antibiotic stewardship: a multisite qualitative study of nurses and infection preventionists.","volume":"46","author":"Carter","year":"2018","journal-title":"Am J Infect Control"},{"issue":"6","key":"zoi260921r12","doi-asserted-by":"publisher","first-page":"1888","DOI":"10.1016\/j.jaip.2019.02.036","article-title":"Patient and primary care physician perceptions of penicillin allergy testing and subsequent use of penicillin-containing antibiotics: a qualitative study.","volume":"7","author":"Wanat","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"9","key":"zoi260921r13","doi-asserted-by":"publisher","first-page":"2958","DOI":"10.1016\/j.jaip.2020.08.018","article-title":"Patient characteristics and concerns about drug allergy: a report from the United States Drug Allergy Registry.","volume":"8","author":"Blumenthal","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"6","key":"zoi260921r14","doi-asserted-by":"publisher","first-page":"489","DOI":"10.2500\/aap.2014.35.3791","article-title":"Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population.","volume":"35","author":"Albin","year":"2014","journal-title":"Allergy Asthma Proc"},{"issue":"7","key":"zoi260921r15","doi-asserted-by":"publisher","first-page":"e266","DOI":"10.1542\/hpeds.2022-006695","article-title":"Racism, not race: the root of racial disparities in penicillin allergy labeling.","volume":"12","author":"Gilliam","year":"2022","journal-title":"Hosp Pediatr"},{"issue":"6","key":"zoi260921r16","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1542\/peds.2014-3056","article-title":"Variation in antimicrobial prescribing for otitis media by race: different wrinkle in disparity?","volume":"134","author":"Woods","year":"2014","journal-title":"Pediatrics"},{"issue":"10","key":"zoi260921r17","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1007\/s00403-024-03460-9","article-title":"Representation of diverse skin tones in Nelson\u2019s Textbook of Pediatrics.","volume":"316","author":"Gruver","year":"2024","journal-title":"Arch Dermatol Res"},{"issue":"12","key":"zoi260921r18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.40798","article-title":"Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.","volume":"4","author":"Wurcel","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi260921r19","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2022.283","article-title":"Exploring the intersection of racism, antimicrobial resistance, and vaccine equity.","volume":"2","author":"Abdul-Mutakabbir","year":"2022","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"issue":"8","key":"zoi260921r20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.28714","article-title":"Geospatial socioeconomic indicators and penicillin allergy delabeling in primary care patients.","volume":"8","author":"Blumenthal","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi260921r21","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research.","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"zoi260921r22","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback.","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"issue":"8","key":"zoi260921r23","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1016\/j.socscimed.2010.07.030","article-title":"The public health critical race methodology: praxis for antiracism research.","volume":"71","author":"Ford","year":"2010","journal-title":"Soc Sci Med"},{"issue":"1","key":"zoi260921r24","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1089\/heq.2021.0075","article-title":"Beyond virtue-signaling: advancing equity through design justice and public health critical race praxis.","volume":"6","author":"Huffstetler","year":"2022","journal-title":"Health Equity"},{"issue":"1","key":"zoi260921r25","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s13012-025-01450-7","article-title":"The Consolidated Framework for Implementation Research (CFIR) User Guide: a five-step guide for conducting implementation research using the framework.","volume":"20","author":"Reardon","year":"2025","journal-title":"Implement Sci"},{"issue":"1","key":"zoi260921r26","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s13012-015-0295-0","article-title":"Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study.","volume":"10","author":"Waltz","year":"2015","journal-title":"Implement Sci"},{"issue":"8","key":"zoi260921r27","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1007\/s11606-012-2037-1","article-title":"A new taxonomy for stakeholder engagement in patient-centered outcomes research.","volume":"27","author":"Concannon","year":"2012","journal-title":"J Gen Intern Med"},{"issue":"1","key":"zoi260921r35","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12913-017-2031-8","article-title":"Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework.","volume":"17","author":"Sekhon","year":"2017","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"zoi260921r37","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2024-002890","article-title":"Factors influencing implementation and adoption of direct oral penicillin challenge for allergy delabelling: a qualitative evaluation.","volume":"13","author":"Jani","year":"2024","journal-title":"BMJ Open Qual"},{"issue":"6","key":"zoi260921r38","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1136\/ejhpharm-2017-001451","article-title":"A UK hospital survey to explore healthcare professional views and attitudes to patients incorrectly labelled as penicillin allergic: an antibiotic stewardship patient safety project.","volume":"26","author":"Wilcock","year":"2019","journal-title":"Eur J Hosp Pharm"},{"issue":"2","key":"zoi260921r39","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1136\/ejhpharm-2019-001863","article-title":"Focus group study exploring the issues and the solutions to incorrect penicillin allergy-labelled patients: an antibiotic stewardship patient safety initiative.","volume":"28","author":"Powell","year":"2021","journal-title":"Eur J Hosp Pharm"},{"issue":"1","key":"zoi260921r40","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlae014","article-title":"Non-allergist healthcare workers views on delivering a penicillin allergy de-labelling inpatient pathway: identifying the barriers and enablers.","volume":"6","author":"Powell","year":"2024","journal-title":"JAC Antimicrob Resist"},{"issue":"4","key":"zoi260921r41","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlaf144","article-title":"Penicillin allergy de-labelling implementation intervention in a UK hospital: a process evaluation, the patient experience.","volume":"7","author":"Powell","year":"2025","journal-title":"JAC Antimicrob Resist"},{"issue":"6","key":"zoi260921r42","doi-asserted-by":"publisher","first-page":"e1148","DOI":"10.1093\/cid\/ciag082","article-title":"Direct oral challenge for penicillin allergy: the International Network of Antibiotic Allergy Nations (iNAAN) Study.","volume":"82","author":"Mitri","year":"2026","journal-title":"Clin Infect Dis"},{"issue":"12","key":"zoi260921r43","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1001\/jama.1936.02770120008002","article-title":"History taking in allergic diseases.","volume":"106","author":"Rackemann","year":"1936","journal-title":"JAMA"},{"issue":"4","key":"zoi260921r44","doi-asserted-by":"publisher","first-page":"693","DOI":"10.5811\/westjem.2018.4.37453","article-title":"Anaphylaxis-related malpractice lawsuits.","volume":"19","author":"Lindor","year":"2018","journal-title":"West J Emerg Med"},{"issue":"5","key":"zoi260921r45","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.anai.2018.03.010","article-title":"Systematic review of professional liability when prescribing \u00df-lactams for patients with a known penicillin allergy.","volume":"121","author":"Jeffres","year":"2018","journal-title":"Ann Allergy Asthma Immunol"},{"issue":"5","key":"zoi260921r46","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1016\/j.jaci.2021.09.020","article-title":"Structural racism and its pathways to asthma and atopic dermatitis.","volume":"148","author":"Martinez","year":"2021","journal-title":"J Allergy Clin Immunol"},{"issue":"6","key":"zoi260921r47","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1016\/j.jaci.2023.01.032","article-title":"Epigenetics and social inequalities in asthma and allergy.","volume":"151","author":"Clausing","year":"2023","journal-title":"J Allergy Clin Immunol"},{"issue":"2","key":"zoi260921r48","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.jaip.2023.11.005","article-title":"Pharmacoequity in allergy-immunology: disparities in access to medications for allergic diseases and proposed solutions in the United States and globally.","volume":"12","author":"Maldonado-Puebla","year":"2024","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"12","key":"zoi260921r49","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001139","article-title":"The primacy of public health considerations in defining poor quality medicines.","volume":"8","author":"Newton","year":"2011","journal-title":"PLoS Med"},{"issue":"6","key":"zoi260921r51","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1093\/cid\/ciaa194","article-title":"Penicillin allergy testing is cost-saving: an economic evaluation study.","volume":"72","author":"Sousa-Pinto","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"7","key":"zoi260921r53","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1016\/j.amjmed.2024.03.020","article-title":"Primary care: its Pokemon moment.","volume":"137","author":"Becker","year":"2024","journal-title":"Am J Med"},{"issue":"2","key":"zoi260921r54","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s11606-020-06077-6","article-title":"Designed to fail? the future of primary care.","volume":"36","author":"McMahon","year":"2021","journal-title":"J Gen Intern Med"},{"issue":"10","key":"zoi260921r55","doi-asserted-by":"publisher","first-page":"3234","DOI":"10.1111\/jgs.19619","article-title":"Penicillin allergy de-labeling in older adults and long-term care residents: a clinical review.","volume":"73","author":"Shah","year":"2025","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"zoi260921r56","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1056\/NEJMp2204749","article-title":"\u201cREACHing\u201d for equity\u2014moving from regressive toward progressive value-based payment.","volume":"387","author":"Gondi","year":"2022","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi260921r57","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.acap.2016.11.004","article-title":"Parent-reported penicillin allergy symptoms in the pediatric emergency department.","volume":"17","author":"Vyles","year":"2017","journal-title":"Acad Pediatr"},{"issue":"5","key":"zoi260921r58","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1016\/j.anai.2024.01.013","article-title":"Sticky penicillin allergy labels: assessing rates of penicillin allergy relabeling after negative testing in children.","volume":"132","author":"Olds","year":"2024","journal-title":"Ann Allergy Asthma Immunol"},{"key":"zoi260921r32","volume-title":"The SAGE Handbook of Qualitative Research","author":"Denzin","year":"2011","edition":"4th ed"},{"key":"zoi260921r34","volume-title":"Qualitative Data Analysis: A Methods Sourcebook","author":"Miles","year":"2018","edition":"4th ed"},{"key":"zoi260921r36","author":"Santillo"},{"key":"zoi260921r1","unstructured":"National action plan for combating antibiotic-resistant bacteria, 2020-2025. Centers for Disease Control and Prevention, US Dept of Health and Human Services. Accessed January 29, 2026. https:\/\/www.hhs.gov\/sites\/default\/files\/carb-national-action-plan-2020-2025.pdf"},{"key":"zoi260921r5","unstructured":"Is it really a penicillin allergy? evaluation and diagnosis of penicillin allergy for healthcare professionals. Centers for Disease Control and Prevention, US Dept of Health and Human Services. Accessed January 29, 2026. https:\/\/stacks.cdc.gov\/view\/cdc\/40146"},{"key":"zoi260921r28","unstructured":"Boston-Cambridge-Newton, MA-NH metro area. US Census Bureau.? 2025. Accessed February 24, 2026. https:\/\/data.census.gov\/profile\/Boston-Cambridge-Newton,_MA-NH_Metro_Area?g=310XX00US14460#populations-and-people"},{"key":"zoi260921r29","unstructured":"Community health assets and needs assessment. Center for Community Health and Health Equity, Brigham and Women\u2019s Hospital. 2022. Accessed February 24, 2026. https:\/\/www.brighamandwomens.org\/assets\/BWH\/about-bwh\/pdfs\/2022-chna-report.pdf"},{"key":"zoi260921r30","unstructured":"2020-21 Diversity and inclusion at Mass General. Center for Diversity and Inclusion, Massachusetts General Hospital. August 2020. Accessed February 24, 2026. https:\/\/www.massgeneral.org\/assets\/MGH\/pdf\/surgery\/2020-21_Diversity_and_Inclusion_at_Mass_General.pdf"},{"key":"zoi260921r31","unstructured":"Diversity, inclusion, and health equity highlights report 2023. Center for Diversity, Equity and Inclusion, TuftsMedicine. Accessed February 24, 2026. https:\/\/www.tuftsmedicine.org\/sites\/default\/files\/2023-10\/tufts-medicine-diversity-inclusion-and-health-equity-highlights-report-2023_0.pdf"},{"key":"zoi260921r33","unstructured":"Dedoose. SocioCultural Research Consultants, LLC. 2021. Accessed January 29, 2026. http:\/\/www.dedoose.com"},{"key":"zoi260921r50","unstructured":"CUBAnet. Penicillin withdrawn from pharmacies and hospitals in Guines. Accessed January 29, 2026. https:\/\/www.cubanet.org\/htdocs\/CNews\/y03\/jan03\/02e1.htm"},{"key":"zoi260921r52","unstructured":"AAAAI reintroduces bill to support penicillin allergy delabeling. News release. American Academy of Allergy Asthma & Immunology; October 13, 2025. Accessed January 29, 2026. https:\/\/www.aaaai.org\/about\/news\/news\/2025\/bill-penicillin#"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2854058\/wurcel_2026_oi_260921_1788884301.56839.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:00:26Z","timestamp":1789484426000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2854058"}},"subtitle":["A Qualitative Study"],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":58,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.33825","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}