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Barriers to Pediatric Sickle Cell Disease Guideline Recommendations
Michael D Cabana1,2, Julie Kanter3, Anne M Marsh4
1University of California, San Francisco, CA, USA.
Insights
Adherence to sickle cell anemia guidelines is low for transcranial Doppler (TCD) screening (46%) and hydroxyurea (HU) counseling (72%). Improving TCD screening requires addressing patient follow-up, while HU counseling needs to overcome practice barriers and physician agreement.
Area of Science:
- Hematology
- Public Health
- Clinical Practice Guidelines
Background:
- National guidelines advocate for annual transcranial Doppler (TCD) screening for stroke risk in children with sickle cell anemia (SCA).
- Guidelines also recommend counseling all SCA patients on hydroxyurea (HU) therapy benefits.
Purpose of the Study:
- To assess factors contributing to low adherence to recommended TCD screening and HU counseling among SCA clinicians.
- To identify specific barriers hindering the implementation of these guideline-recommended practices.
Main Methods:
- A national survey was conducted among sickle cell disease (SCD) clinicians.
- Data collected focused on adherence rates and perceived barriers to TCD screening and HU counseling.
Main Results:
- Adherence to annual TCD screening was 46%, significantly associated with low outcome expectancy regarding patient follow-up.
- Adherence to HU counseling was 72%, with low adherence linked to practice barriers (e.g., time, staff) and lack of physician agreement with recommendations.
- Distinct factors influenced adherence to TCD screening versus HU counseling.
Conclusions:
- Improving TCD screening requires strategies to enhance patient follow-up and testing accessibility.
- Enhancing HU counseling adherence necessitates addressing physician agreement with guidelines and overcoming practice-related obstacles.
- Tailored interventions are crucial for optimizing adherence to different SCA management guidelines.
Abstract:
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).
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