Barriers to Pediatric Sickle Cell Disease Guideline Recommendations.
Barriers to Pediatric Sickle Cell Disease Guideline Recommendations.
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DOI：
10.1177/2333794x19847026
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发表时间：
2019-01-01
影响因子：
2.2
通讯作者：
Bardach, Naomi S
中科院分区：
文献类型：
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作者：
Cabana, Michael D;Kanter, Julie;Bardach, Naomi S
国家指南建议医生向所有镰状细胞性贫血患者咨询羟基脲（HU）治疗，并每年用经颅多普勒（TCD）筛查镰状细胞性贫血儿童卒中风险。我们调查了全国镰状细胞病临床医生的便利样本，以评估与低依从性相关的因素。TCD筛查依从性为46%。低依从性与缺乏结果预期相关（例如，认为患者对TCD检测的随访会很差；P < 0.05）。HU咨询的依从性为72%。实践障碍（例如，缺乏支持人员或时间）和缺乏与HU建议的一致性与低依从性相关（P < 0.05）。这项研究表明，需要不同类型的策略来改善TCD筛查（以解决随访和获得测试的问题）和HU咨询（以解决医生同意和实践障碍）。
National guidelines recommend that providers counsel all patients with sickle cell anemia about hydroxyurea (HU) therapy and screen children with sickle cell anemia annually for the risk of stroke with transcranial Doppler (TCD). We surveyed a national convenience sample of sickle cell disease clinicians to assess factors associated with low adherence. Adherence was 46% for TCD screening. Low adherence was associated with a lack of outcome expectancy (eg, a belief that there would be poor patient follow-up to TCD testing; P < .05). Adherence was 72% for HU counseling. Practice barriers (eg, lack of support staff or time) and a lack of agreement with HU recommendations were associated with low adherence (P < .05). This study demonstrates that different types of strategies are needed to improve TCD screening (to address follow-up and access to testing) versus HU counseling (to address physician agreement and practice barriers).