Inclusive and intersectoral: community health improvement planning opportunities to advance the social determinants of health and health equity.

BACKGROUND: Community health improvement plans (CHIPs) are strategic planning tools that help local communities identify and address their public health needs. Many local health departments have developed a CHIP, yet there is a lack of research on the extent to which these plans address root causes of health disparities such as the social determinants of health. This study aims to inventory the social determinants of health included in 13 CHIPs and examine facilitators and challenges faced by local health departments and partners when trying to include the social determinants of health. METHODS: We conducted a comparative plan evaluation by scoring 13 CHIPs on their inclusion of equity orientation, inclusive planning processes, and five social determinants of health: health care access and quality, the neighborhood and built environment, economic stability, social and community context, and education access and quality. To supplement the plan evaluation, we conducted 32 in-depth interviews with CHIP leaders and stakeholders to understand the factors contributing to the inclusion and exclusion of the social determinants of health in the planning process. RESULTS: CHIPs received an average score of 49/100 for the inclusion of the social determinants of health. Most plans addressed health care access and quality and the neighborhood and built environment, but they often did not address economic stability, the social and community context, and education access and quality. Regarding their overall equity orientation, CHIPs received an average score of 35/100, reflecting a relative lack of attention to equity and inclusive planning processes in the plans. Interviews revealed that challenges engaging partners, making clear connections between CHIPs and social determinants, and a lack of capacity or public and partner support often led to the exclusion of the social determinants of health. Recommendations to improve planning processes include improving data infrastructure, providing resources for dedicated planning staff and community engagement incentives, and centering equity throughout the planning process. CONCLUSIONS: Although local health departments can leverage CHIPs to improve population health and address health disparities, they face a range of challenges to including the social determinants of health in CHIPs. Additional resourcing and improved data are needed to facilitate broader inclusion of these determinants, and more work is needed to elevate equity throughout these planning processes.

Establishment and Feasibility of an Immediate Lymphatic Reconstruction Program in a Community Health System.

BACKGROUND: Breast cancer-related lymphedema (BCRL) remains a significant post-surgical complication of breast cancer treatment. Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) has shown promise in preventing BCRL. While the primary literature supporting ILR comes from academic institutions, the majority of breast cancer care in the USA occurs in the community setting. This study evaluated a preventative lymphedema program performing ILR at a community health system. PATIENTS AND METHODS: A prospective database including all patients who underwent ALND with concurrently attempted ILR from 2019 to 2021 was retrospectively reviewed. The historical benchmark lymphedema rate was calculated through retrospective review of electronic medical records for all patients who underwent ALND without ILR from 2011 to 2021. RESULTS: Ninety patients underwent ALND with ILR, of which ILR was successful in 69 (76.7%). ILR was more likely to be aborted in smokers (p < 0.05) and those with fewer lymphatic channels (p < 0.05) or a higher body mass index (BMI) (p = 0.08). Patients with successful versus aborted ILR had lower lymphedema rates (10.9% versus 66.7%, p < 0.01) and improved Disability of the Arm, Shoulder, and Hand (DASH) scores (8.7 versus 19.8, p = 0.25), and lower lymphedema rates than the historical benchmark (10.9% versus 50.2%, p < 0.01). Among patients with successful ILR, older patients were more likely to develop lymphedema (p < 0.05). CONCLUSIONS: Successful ILR after ALND significantly reduced the lymphedema rate when compared with patients with aborted ILR and our institution's historical benchmark. Our experience supports the efficacy of ILR and highlights the feasibility of ILR within a community health system.

Availability, stock levels and usage of In-vitro diagnostics in the Bono region, Ghana: A cross-sectional study.

BACKGROUND: Point-of-care (POC) diagnostic tests play essential roles in diagnosis, surveillance, and disease management in health settings. Nevertheless, implementation challenges may hamper POC test accessibility. This study evaluated the availability and stock levels of the World Health Organization (WHO) prequalified existing in-vitro diagnostics (IVDs) for use in health facilities without laboratories. AIM: To evaluate the availability, stock levels, and usage of POC diagnostic tests. SETTING: Bono Region, Ghana. METHODS: This cross-sectional survey involved 102 randomly selected Community Health-based and Planning Services (CHPS), 12 district health depots, and a regional medical depot. Using a survey tool, data were collected on clinic staffing, availability and stock levels of tests, and funding sources. STATA 17 was employed for data analysis. RESULTS: Majority (37.3%) of the respondents were community health nurses, with 4.4 mean years of work experience and 38 working hours per week. Of the 18 existing WHO prequalified POC tests for use at facilities without laboratories, 10 (56%), 2 (11%) and 0 (0%) were found at CHPS, regional, and district depots, respectively. Majority (183 out of 301) stock levels were low. Of the 10 available tests found, 7 scored 111 (36%) of 'high use'. Supply chain management compliance was 5 (31%) out of 16. All CHPS received government funding with 25.5% of them receiving additional donor or internally generated funding. CONCLUSION: This study found poor supply chain management compliance, and low availability of POC tests in the Bono Region of Ghana.Contribution: The study outlines POC tests availability and usage in low-resourced setting.

Enhancing community health system resilience: lessons learnt during the COVID-19 pandemic in Uganda through the qualitative inquiry of the COVID Task Force.

Objective: This study aimed to explore the elements of a resilient community health system during the COVID-19 pandemic and discuss whether the frameworks described in previous studies can be applied to real-world situations with those who implemented the Community Engagement Strategy, a strategy to make health systems work in their communities during health crises in Uganda. Methods: Focus group discussions (22 participants in total) were conducted with COVID Task Force members in four districts in Uganda in March 2022. These districts implemented a Community Engagement Strategy to ensure that health systems in their communities continued to function during health scares, and have been evaluated to ensure that the strategies have been implemented. Results: A thematic analysis was applied. From the results some factors which can enhance the resiliency of community health systems were identified: including health "knowledge," "communication," "governance," and "resources" health. The most important elements changed depending on the phase of the outbreak. VHTs are the key players in the transition from knowledge-and resource-oriented initiatives to communication and governance by community residents. Conclusion: COVID-19, a new infectious disease, provides lessons for a resilient community health system. First, the health system should be flexible enough to be able to change the elements on which it is focused, and second, VHTs play an important role in the flexibility of the health system. This suggests that it is time to assess whether VHTs are still able to continue their activities after the pandemic is over, and whether the environment, including financial and non-financial support, has improved.

Implementing patient-public engagement for improved health: Lessons from three Ghanaian community-based programmes.

BACKGROUND: Community-based health interventions have been implemented as a key strategy for achieving improved health outcomes in Ghana. Effectiveness, however, largely depends on the successful implementation of patient-public engagement (PPE). Although several PPE studies have been conducted in Ghana, little research has been done to understand the specific role of PPE in the context of implementing community-based health programmes. This paper, therefore, examines the extent of PPE implementation in three selected community-based health programmes (Community-based Health Planning and Service [CHPS], Community-based Maternal and Child Health and Buruli Ulcer) to understand their specific effects on health outcomes. METHODS: Three focus groups, involving 26 participants, were held in three districts of the Ashanti region of Ghana. Participants were mainly health service users involving community health committee members/volunteers, residents and health professionals. They were invited to participate based on their roles in the design and implementation of the programmes. Participants focused on each of Rifkin's spider-gram components. Data were transcribed and analysed descriptively using NVIVO 12 Plus. RESULTS: PPE implementation was found to be extensive across the three programmes in specific areas such as organisation and resource mobilisation. PPE was more restricted in relation to community needs assessment, leadership and management, particularly for the CHPS and Buruli Ulcer programmes. CONCLUSION: Findings suggest that benefits from community-based health interventions are likely to be greater if PPE can be widely implemented across all dimensions of the spider-gram framework.

A importância do Sistema Único de Saúde para o aprimoramento da Saúde Coletiva / The importance of the Unified Health System for improving Public Health

O artigo pretende resgatar a relevância do Sistema Único de Saúde (SUS) como Política Pública que alicerça a promoção e prevenção da saúde coletiva. A metodologia utilizada foi a revisão integrativa da literatura a partir da busca de artigos em Lilacs, MedLine e Scielo, utilizando os descritores: SUS, Saúde Coletiva e Pública e História da Saúde. Procedeu-se ao cruzamento dos descritores para elucidar as implicações de ações de promoção e prevenção em saúde para o aprimoramento da saúde coletiva.a utilização de escalas como a PUSH na avaliação dos cuidados prestados é essencial para nortear o atendimento.(AU)

This article aims to rescue the relevance of the Unified Health System (SUS) as a Public Policy that underpins the promotion and prevention of collective health. The methodology used was an integrative literature review from the search for articles in Lilacs, MedLine and Scielo databases, using the descriptors: SUS, Collective and Public Health, History of Health. The descriptors were crossed to elucidate the implications of actions with promotion and prevention for the improvement of collective health(AU)

Este artículo tiene como objetivo destacar la importancia del Sistema Único de Salud (SUS) como política pública que sustenta la promoción y prevención de la salud colectiva. La metodología utilizada fue una revisión bibliográfica integradora basada en la búsqueda de artículos en Lilacs, MedLine y Scielo, utilizando los descriptores: SUS, Salud Colectiva y Pública e Historia de la Salud. Los descriptores fueron cruzados para dilucidar las implicaciones de las acciones de promoción y prevención de la salud en la mejora de la salud colectiva.(AU)

Evaluation of Community Benefit Activities Among Nonprofit Hospitals, 2018-2021.

OBJECTIVE: This study examined approaches that nonprofit hospitals use to evaluate community benefit activities in the Community Health Needs Assessment/Implementation Plan (CHNA/IP) process. DESIGN: Content analysis of CHNAs/IPs completed between 2018 and 2021 from a 20% stratified random sample (n = 503) of US nonprofit hospitals. MAIN OUTCOME MEASURES: A coding sheet was used to record details about the evaluation content reported by hospitals in their CHNAs/IPs. Evaluation was coded into 4 categories: (1) no mention of evaluation; (2) description of evaluation without reporting any measures; (3) reporting reach (number of people served) only; and (4) reporting social/health outcomes. For logistic regression analyses, categories 1 and 2 were grouped together into "no evaluation measures" and categories 3 and 4 were grouped into "evaluation measures" for binary comparison. Multinomial logistic regression was also used to individually examine categories 3 and 4 compared with no evaluation measures. RESULTS: While a majority of nonprofit hospitals (71.4%, n = 359) mentioned evaluation in their CHNAs, almost half (49.7%, n = 250) did not report any evaluation measures. Among the 50.3% (n = 253) of hospitals that reported evaluation measures, 67.2% (n = 170) only reported reach. Fewer than 1 in 5 hospitals (16.5%, n = 83) reported social/health outcomes. Hospitals that hired a consultant (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [CI], 1.08-2.43) and system members (AOR = 1.76; 95% CI, 1.12-2.75) had higher odds of reporting evaluation measures. Using hospitals that reported no measures as the base category, system members (AOR = 7.71; 95% CI, 2.97-20.00) also had significantly higher odds of reporting social/health outcomes, while rural locations had lower odds (AOR = 0.43; 95% CI, 0.20-0.94). CONCLUSIONS: Although hospitals are required to evaluate the impact of actions taken to address the health needs identified in their CHNAs, few hospitals are reporting social/health outcomes of such activities. This represents a missed opportunity, as health/social outcomes could be used to inform the allocation of resources to maximize community benefits and the expansion of successful community initiatives.

Participação em saúde como elemento indissociável para o fortalecimento dos sistemas de atenção à saúde nas Américas

[RESUMO]. A presente revisão narrativa discute a relevância e os desafios da participação em saúde para o fortalecimento dos sistemas de atenção à saúde. Partindo de uma definição de participação em saúde como um processo dinâmico que dá às pessoas acesso e controle sobre os recursos de saúde por meio de envolvimento e experiência, o artigo sintetiza informações obtidas em documentos e debate em um evento internacional (Seminario Internacional: Experiencias y Modelos de Participación en Salud en América Latina y el Caribe). A esse material, foram agregados os resultados de buscas nas bases SciELO, PubMed e Google Acadê- mico utilizando os termos “community participation”, “community engagement”, “social control” e “community health planning”. Foram selecionados artigos de revisão e de opinião em âmbito nacional ou transnacional, sem limite de data ou idioma. A participação em saúde é um conceito atual, legitimado nas recomenda- ções para políticas de saúde descritas em documentos e publicações recentes. Em todo o mundo, cresce o número de estudos sobre o assunto; porém, nas Américas, três países (Estados Unidos, Canadá e Brasil) concentram a maioria das publicações. Os estudos abordam questões oportunas e demonstram consenso entre os pesquisadores de cada grupo independente. Entretanto, a área carece de intercâmbios e análises comparativas que contrastem diferentes experiências que transcendam as fronteiras nacionais e ampliem o conhecimento sobre a participação em saúde. Aconselha-se a criação de espaços de troca de experiências e oportunidades de pesquisa, bem como o estabelecimento de redes profissionais e de pesquisa no campo da participação em saúde.

[ABSTRACT]. The present narrative review discusses the relevance and challenges of community participation in health for health system strengthening. Based on a definition of community participation in health as a dynamic process that gives people access and control over health resources through involvement and experience, the article summarizes information obtained from documents and debate at an international event (Seminario Interna- cional: Experiencias y Modelos de Participación en Salud en América Latina y el Caribe). In addition, the SciELO, PubMed and Google Scholar databases were searched using the terms “community participation”, “community engagement”, “social control” and “community health planning” to identify national or transnatio- nal review and opinion articles. Community participation in health is a current concept, acknowledged in the recommendations for health policies described in recent documents and publications. Around the world, the number of studies on the subject is growing; however, in the Americas, three countries (United States, Canada and Brazil) accounted for most of the scientific publications identified in the databases. The studies address timely questions and show consensus among investigators within each individual research group. However, the area lacks exchanges and comparative analyses that contrast different experiences transcending national borders and expanding knowledge on community participation in health. The creation of more spaces for the sharing of experiences and research is advised, as well as the establishment of professional and research networks in the field of community participation in health.

[RESUMEN]. En esta revisión narrativa se analizan la relevancia y los retos de la participación en salud para el fortaleci- miento de los sistemas de atención de salud. A partir de una definición de la participación en salud como un proceso dinámico que da a las personas acceso y control sobre los recursos de salud por medio de la intervención y la experiencia, en el artículo se sintetiza la información obtenida de documentos y en un debate realizado en el denominado Seminario Internacional: Experiencias y Modelos de Participación en Salud en América Latina y el Caribe. A este material se agregaron los resultados de búsquedas en las bases de datos SciELO, PubMed y Google Académico con los términos “community participation”, “community engagement”, “social control” y “community health planning”. Se seleccionaron artículos de revisión y opinión de los ámbitos nacional o transnacional, sin límite de fecha ni de idioma. La participación en salud es un concepto actual, legitimado en las recomendaciones sobre políticas de salud descritas en documentos y publicaciones recien- tes. El número de estudios sobre el tema ha aumentado en todo el mundo, pero en las Américas, la mayoría de las publicaciones se concentran en tres países (Brasil, Canadá y Estados Unidos). En los estudios se abordan asuntos de actualidad y se demuestra el consenso existente entre los investigadores de cada grupo indepen- diente. Sin embargo, en este campo no hay intercambios ni análisis comparativos que permitan contrastar las diferentes experiencias más allá de las fronteras nacionales y ampliar el conocimiento sobre la participación en salud. Se recomienda crear ámbitos de intercambio de experiencias y oportunidades de investigación, y establecer redes profesionales y de investigación en el campo de la participación en salud.

Bottom-up innovative responses to COVID-19 in Latin America and the Caribbean: addressing deprioritized populations

[ABSTRACT]. Objective. To identify and describe innovative initiatives implemented as a response to the interruption of health services during the COVID-19 pandemic in Latin America and the Caribbean (LAC). Methods. This was a descriptive study that reviewed 34 initiatives implemented during the COVID-19 pan- demic in LAC to address health services needs among deprioritized groups. The review of initiatives included four phases: a call for submissions of innovative initiatives from LAC countries; a selection of initiatives that had the ability to address health services gaps and that were innovative and effective; systematization and cataloging of the selected initiatives; and a content analysis of the information collected. Data were analyzed from September to October 2021. Results. The 34 initiatives show important variations regarding the target populations, the stakeholders involved, level of implementation, strategies, scope, and relevance of the innovative initiative. There was also evidence of the emergence of a bottom-up set of actions in the absence of top-down actions. Conclusion. The findings of this descriptive review of 34 initiatives implemented during the COVID-19 pan- demic in LAC suggest that systematizing the strategies and lessons learned has the potential to expand learning for re-establishing and improving post-pandemic health services.

[RESUMEN]. Objetivo. Detectar y describir iniciativas innovadoras instrumentadas como respuesta a la interrupción de los servicios de salud durante la pandemia de COVID-19 en América Latina y el Caribe (ALC). Métodos. Se trata de un estudio descriptivo en el que se examinaron 34 iniciativas instrumentadas durante la pandemia de COVID-19 en ALC para hacer frente a las necesidades de servicios de salud en grupos poblacionales desatendidos. La revisión constó de cuatro fases: convocatoria para la presentación de ini- ciativas innovadoras por parte de los países de la Región; selección de iniciativas capaces de abordar las deficiencias en los servicios de salud y que fueran innovadoras y eficaces; sistematización y clasificación de las iniciativas seleccionadas; y análisis del contenido de la información recopilada. Los datos se analizaron entre septiembre y octubre del 2021. Resultados. Las 34 iniciativas presentan importantes diferencias en cuanto a los grupos poblacionales desti- natarios, las partes interesadas implicadas, el grado de aplicación, las estrategias, el alcance y la pertinencia de la iniciativa innovadora. También se constató el surgimiento de un conjunto de acciones generadas desde la base como respuesta a la ausencia de medidas aplicadas de forma descendente. Conclusión. Los resultados de esta revisión descriptiva de 34 iniciativas aplicadas en ALC durante la pan- demia de COVID-19 sugieren que la sistematización de las estrategias y las enseñanzas extraídas podría ser útil para ampliar el aprendizaje con vistas al restablecimiento y la mejora de los servicios de salud pospandémicos.

[RESUMO]. Objetivo. Identificar e descrever iniciativas inovadoras implementadas em resposta à interrupção dos serviços de saúde durante a pandemia de COVID-19 na América Latina e no Caribe (ALC). Métodos. Este estudo descritivo analisou 34 iniciativas implementadas durante a pandemia de COVID-19 na ALC para atender às necessidades de serviços de saúde entre grupos que haviam perdido prioridade. A análise das iniciativas incluiu quatro fases: chamada pública para a apresentação de iniciativas inovadoras de países da ALC; seleção de iniciativas inovadoras e efetivas capazes de abordar lacunas nos serviços de saúde; sistematização e catalogação das iniciativas selecionadas; e análise de conteúdo das informações coletadas. Os dados foram analisados de setembro a outubro de 2021. Resultados. As 34 iniciativas apresentam variações importantes com relação às populações-alvo, partes interessadas envolvidas, nível de implementação, estratégias, escopo e relevância da iniciativa inovadora. Também houve evidências do surgimento de um conjunto de ações de baixo para cima (bottom-up) na aus- ência de ações de cima para baixo (top-down). Conclusão. Os resultados desta análise descritiva de 34 iniciativas implementadas durante a pandemia de COVID-19 nos países da ALC sugerem que a sistematização das estratégias e das lições aprendidas tem o potencial de ampliar as oportunidades de aprendizado para reestabelecer e aprimorar os serviços de saúde pós-pandemia.

The contribution of community health systems to resilience: Case study of the response to the 2015 earthquake in Nepal.

Methods: Key informant interviews and focus group discussions were utilised. Participants included FCHVs, primary healthcare workers, community leaders and mothers, district health managers, representatives from the Ministry of Health and Population, multilateral health organisations, bilateral development partners, local non-governmental organisations, community-based organisations, and international non-governmental organisations. We used thematic content analysis to identify emerging themes. Results: Seventy-seven people participated in the study in September 2016 from communities (n = 53, 69%), districts (n = 8, 10%), and national levels (n = 16, 21%). Strong coordination, international and national support, and community engagement and participation were reported as successes of the earthquake response. Challenges included a lack of preparedness and supplies, a lack of earthquake-resistant infrastructure, and the centralisation of the response. FCHVs continued to work, despite being victims of the earthquake themselves. Facilitators of the continuation of the FCHVs' duties included their strong ties with the communities and facilities, international support, and the ability to mobilise existing community resources. Barriers included fear, communities' attitudes, high workloads, large geographic distances, and difficult geography. Participants identified the importance of having strong, connected, and supported communities, adaptable funding and policies, and decentralised decision-making within strong health systems. Conclusions: Building resilience in community-based health systems must start with strong communities that are prepared, trained, equipped, and empowered. Health systems must be decentralised and adaptable, with strong coordination and leadership. Capable community health workers such as FCHVs were an important part of building resilience during the earthquake. These lessons can assist countries in strengthening decentralised health systems to better respond to a multitude of shocks, while still providing essential health services for communities.

Impact of community health interventions on maternal and child health indicators in the upper east region of Ghana.

BACKGROUND: This paper reports on results of a health system strengthening implementation research initiative conducted the Upper East Region of northern Ghana. Transformative interventions to accelerate and strengthen the health delivery were implemented that included empowering community leaders and members to actively participate in health delivery, strengthening the referral systems through the provision of community transport systems, providing basic medical equipment to community clinics, and improving the skills of critical health staff through training. METHODS: A mixed method design was used to evaluate the impact of the interventions. A quantitative evaluation employed a flexible research design to test the effects of various component activities of the project. To assess impact, a pre-versus-post randomized cluster survey design was used. Qualitative research was conducted with focus group data and individual in depth interviews to gauge the views of various stakeholders associated with the implementation process. RESULTS: After intervention, significant improvements in key maternal and child health indicators such as antenatal and postnatal care coverage were observed and increases in the proportion of deliveries occurring in health facilities and assisted by skilled health personnel relative to pre-intervention conditions. There was also increased uptake of oral rehydration salts (ORS) for treatment of childhood diarrhoea, as well as marked reductions in the incidence of upper respiratory infections (URI). CONCLUSIONS: A pre-and post-evaluation of impact suggests that the programme had a strong positive impact on the functioning of primary health care. Findings are consistent with the proposition that the coverage and content of the Ghana Community-based Health Planning and Services programme was improved by program interventions and induced discernable changes in key indicators of health system performance.

Community Health Improvement Plans and Physical Activity Implementation Strategies: Findings From a Cross-Sectional Survey of US Local Health Departments.

OBJECTIVE: Community Health Improvement Plans (CHIPs) are a foundational public health practice conducted by every accredited health department in the United States. Community Health Improvement Plans may impact community-wide physical activity (PA) by implementing large-scale interventions. However, no studies have evaluated whether, or how, CHIP goals focusing on increasing PA are implemented. This study aims to understand CHIP PA goals, implementation strategies, and implementation outcomes of CHIP nationally. DESIGN: This study was a cross-sectional online survey of CHIP implementation. SETTING: A random sample of accredited local health departments nationally. PARTICIPANTS: Local health departments (N = 44) were invited to participate in this study. MAIN OUTCOME MEASURES: Constructs from Proctor's Model of Implementation Research and implementation strategies were the main outcomes assessed. RESULTS: Most CHIPs included PA goals (72.7%). Goals most commonly focused on changing built environment and infrastructure (25.9%), increasing education and awareness (22.2%), increasing PA programming (18.5%), and partnering with health care (18.5%). Common implementation strategies used were designing and evaluating their CHIPs (72.7%) and developing relationships with stakeholders (72.7%). Respondents reported that CHIPS were able to be adopted, acceptable for the community, and feasible. Community Health Improvement Plans were also reported to be safe, yet respondents reported effectiveness lower than other constructs. Participants reported that individual-level PA was unlikely to change due to their CHIP (mean = 3.39, SD = 1.12). CONCLUSIONS: Overall, it seems that communities are choosing easily adopted, appropriate, feasible, and safe interventions that may be less effective over those that may produce large-scale improvement in PA behavior. Future research needs to be conducted on the process of CHIP implementation and the potential long-term outcomes. Community Health Improvement Plans may serve as a powerful tool to improve population health if implemented effectively.

Evaluation of a pharmacist-led penicillin allergy testing service in a community health system.

BACKGROUND: Roughly 10% of the U.S. population has a documented penicillin (PCN) allergy. Among these individuals, over 95% are able to tolerate PCNs. The inability to use PCNs can result in suboptimal outcomes. In August 2019, Lawrence Memorial Hospital Health System implemented a pharmacist-led PCN allergy testing service to assist with delabeling PCN allergies and increase access to this class of antibiotics. OBJECTIVES: The primary objective was to describe the number of patients who underwent PCN allergy testing and were delabeled from PCN allergy. A secondary objective was to report the number of patients who received and tolerated PCN antibiotics after being delabeled from PCN allergy. METHODS: This retrospective chart review was conducted during the initial 17 months of a pharmacist-led PCN allergy testing service. Eligible patients with a history of an immunoglobulin E (IgE)-mediated reaction underwent a 3-step test that consisted of a scratch test, an intradermal test, and an oral challenge. Eligible patients who did not have a history of IgE-mediated reaction underwent a 2-step graded oral challenge. Descriptive statistics were used for data analysis. RESULTS: Between August 2019 and January 2022, 70 patients underwent testing, and 66 patients were delabeled from PCN allergy. Four patients who underwent the 3-step test developed reactions of mild to moderate severity. All patients who underwent the graded oral challenge were delabeled from PCN allergy. The rate of PCN allergy was 5.7%, whereas the rate of type I IgE-mediated reaction was 1.4%. All 23 patients who received an antibiotic from the PCN class after a negative allergy test tolerated the PCN antibiotic without an incident. CONCLUSION: PCN allergy testing is an effective way to delabel PCN allergies from most patients presenting with a PCN allergy history. Skin testing followed by an oral challenge or a graded oral challenge alone are safe methods for conducting PCN allergy testing in the primary care setting.