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Physicians' perceptions of factors influencing adherence to antibiotic prophylaxis in children with sickle cell
Keele E Wurst1, Betsy L Sleath1, Thomas R Konrad2
1Schools of Pharmacy and Public Health, and.
Insights
Physicians
Area of Science:
- Pediatric Hematology
- Infectious Disease Prevention
Background:
- Children under 5 with sickle cell disease (SCD) face high infection risk due to spleen dysfunction.
- Antibiotic prophylaxis is crucial for preventing invasive infections like those caused by Staphylococcus pneumoniae and Haemophilus influenzae.
Purpose of the Study:
- To investigate physicians' views on factors influencing antibiotic prophylaxis adherence in children with SCD.
- To determine how physician characteristics correlate with these perceptions.
Main Methods:
- Literature search (1996-2002) on SCD, compliance, children, physician perceptions, and antibiotic prophylaxis.
- Survey distributed to North Carolina pediatricians and hematologists assessing perceptions of adherence factors.
- Demographic data matched and correlated with survey responses.
Main Results:
- A 56.9% response rate was achieved.
- Physician race and specialty significantly influenced perceived importance of adherence factors.
- A majority of physicians recognized common adherence issues, but ethnic differences were noted.
Conclusions:
- Physician ethnicity impacts perceptions of adherence factors for antibiotic prophylaxis in children with SCD.
- Discrepancies exist between perceived and actual factors affecting adherence.
- Continuing education for physicians is recommended, emphasizing adherence factors and provider demographics.
Background:
Children with sickle cell disease (SCD) aged <5 years are at great risk for invasive infection with Staphylococcus pneumoniae and Haemophilus influenzae due to the inability of their spleen to protect against infection.
Objectives:
This study examined (1) physicians' perceptions of factors associated with adherence to antibiotic prophylaxis in children with SCD and (2) how physician characteristics are associated with these perceptions.
Methods:
A MEDLINE search of the years 1996 to 2002, using the terms sickle cell disease, compliance, children, physician perceptions, and antibiotic prophylaxis, was done. A survey was developed using existing literature to assess physicians' perceptions of factors associated with adherence to antibiotic prophylaxis for SCD. The survey was sent to a stratified random sample of 375 pediatricians and all 125 practicing hematologists in North Carolina. They were given a Likert-type scale to assess their perceptions of factors that influence patients' adherence to antibiotic prophylaxis for SCD. Physician demographic information was collected using the North Carolina Health Professions Data Book. The demographic information was matched to the survey respondent and correlated with his or her responses.
Results:
The response rate was 56.9%. Of the respondents, 60.9% were pediatricians, and 56.5% were in a practice with at least 1 patient aged <5 years with SCD. Physician race and practice specialty were significantly associated with factors physicians considered very important to adherence.
Conclusions:
Most physicians agree on many issues that affect adherence; however, significant and important differences exist, based on physician ethnicity. Physicians' perceptions of factors that affect adherence in this study did not always agree with factors demonstrated to actually affect adherence in SCD patients. Therefore, this study indicates a need for physician continuing-education programs that focus on factors that actually influence adherence of antibiotic prophylaxis and the racial/ethnic backgrounds of the providers in relation to the patient.
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