Objective. We explored factors that may influence physician adherence to transcranial Doppler (TCD) screening guidelines among children with sickle cell disease. Methods. Pediatric hematologists, neurologists, and primary care physicians (n = 706) responded to a mailed survey in May 2012 exploring factors hypothesized to influence physician adherence to TCD screening guidelines: physician (internal) barriers and physician-perceived external barriers. Responses were compared by specialty using chi-square tests. Results. Among 276 physicians (44%), 141 currently treated children with sickle cell disease; 72% recommend screening. Most primary care physicians (66%) did not feel well informed regarding TCD guidelines, in contrast to neurologists (25%) and hematologists (6%, P < .0001). Proportion of correct answers on knowledge questions was low (13%-35%). Distance to a vascular laboratory and low patient adherence were external barriers to receipt of TCD screening. Conclusions. Additional research regarding physicians’ lack of self-efficacy and knowledge of recommendations could help clarify their role in recommendation of TCD screening.
PowarsDWilsonBImbusCPegelowCAllenJ. The natural history of stroke in sickle cell disease. Am J Med. 1978;65:461-471.
2.
RaphaelJLDietrichCLWhitmireDMahoneyDHMuellerBUGiardinoAP. Healthcare utilization and expenditures for low income children with sickle cell disease. Pediatr Blood Cancer. 2009;52:263-267.
3.
ShankarSMArbogastPGMitchelECooperWOWangWCGriffinMR. Medical care utilization and mortality in sickle cell disease: a population-based study. Am J Hematol. 2005;80:262-270.
4.
AdamsRJMcKieVCHsuL. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998;339:5-11.
5.
Ohene-FrempongKWeinerSJSleeperLA. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood. 1998;91:288-294.
6.
BroderickJTalbotGTPrengerELeachABrottT. Stroke in children within a major metropolitan area: the surprising importance of intracerebral hemorrhage. J Child Neurol. 1993;8:250-255.
7.
AdamsRJMcKieVCCarlEM. Long-term stroke risk in children with sickle cell disease screened with transcranial Doppler. Ann Neurol. 1997;42:699-704.
8.
MarkusHS. Transcranial Doppler ultrasound. Br Med Bull. 2000;56:378-388.
GoldsteinLBAdamsRAlbertsMJ. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2006;113:e873-e923.
11.
Section on Hematology/Oncology Committee on Genetics for the American Academy of Pediatrics. Health supervision for children with sickle cell disease. Pediatrics. 2002;109:526-535.
12.
ArnoldFWLaJoieASBrockGN. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. Arch Intern Med. 2009;169:1515-1524.
13.
DambravaPGTorresAVallesX. Adherence to guidelines’ empirical antibiotic recommendations and community-acquired pneumonia outcome. Eur Respir J. 2008;32:892-901.
14.
Erickson FosterJVelascoJMHiekenTJ. Adverse outcomes associated with noncompliance with melanoma treatment guidelines. Ann Surg Oncol. 2008;15:2395-2402.
15.
GroverSCoupalLKouacheMLowensteynIMarchandSCampbellN. Estimating the benefits of patient and physician adherence to cardiovascular prevention guidelines: the MyHealthCheckup Survey. Can J Cardiol. 2011;27:159-166.
16.
WoolfSHGrolRHutchinsonAEcclesMGrimshawJ. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318:527-530.
17.
ReinerZSonickiZTedeschi-ReinerE. Physicians’ perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: the PERCRO-DOC survey. Atherosclerosis. 2010;213:598-603.
18.
BauerMS. A review of quantitative studies of adherence to mental health clinical practice guidelines. Harv Rev Psychiatry. 2002;10:138-153.
19.
FranckeALSmitMCde VeerAJMistiaenP. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008;8:38.
20.
KaluSUHallMC. A study of clinician adherence to treatment guidelines for otitis media with effusion. WMJ. 2010;109:15-20.
21.
MickanSBurlsAGlasziouP. Patterns of ‘leakage’ in the utilisation of clinical guidelines: a systematic review. Postgrad Med J. 2011;87:670-679.
22.
EckrichMJWangWCYangE. Adherence to transcranial Doppler screening guidelines among children with sickle cell disease. Pediatr Blood Cancer. 2013;60:270-274.
23.
Armstrong-WellsJGrimesBSidneyS. Utilization of TCD screening for primary stroke prevention in children with sickle cell disease. Neurology. 2009;72:1316-1321.
24.
RaphaelJLShettyPBLiuHMahoneyDHMuellerBU. A critical assessment of transcranial doppler screening rates in a large pediatric sickle cell center: opportunities to improve healthcare quality. Pediatric Blood Cancer. 2008;51:647-651.
25.
Enninful-EghanHMooreRHIchordRSmith-WhitleyKKwiatkowskiJL. Transcranial Doppler ultrasonography and prophylactic transfusion program is effective in preventing overt stroke in children with sickle cell disease. J Pediatr. 2010;157:479-484.
26.
YusufHRAtrashHKGrosseSDParkerCSGrantAM. Emergency department visits made by patients with sickle cell disease: a descriptive study, 1999-2007. Am J Prev Med. 2010;38(4 suppl):S536-S541.
27.
OvbiageleBAdamsRJ. Trends in comorbid sickle cell disease among stroke patients. J Neurol Sci. 2011;313:86-91.
28.
LeschkeJPanepintoJANimmerMHoffmannRGYanKBrousseauDC. Outpatient follow-up and rehospitalizations for sickle cell disease patients. Pediatr Blood Cancer. 2012;58:406-409.
29.
CabanaMDRandCSPoweNR. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458-1465.
30.
McCarvilleMBGoodinGSFortnerG. Evaluation of a comprehensive transcranial Doppler screening program for children with sickle cell anemia. Pediatr Blood Cancer. 2008;50:818-821.
31.
CabanaMDRandCSlishKNanBDavisMMClarkN. Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking. Pediatrics. 2004;113(1pt 1):78-81.
32.
ChrismanSPSchiffMARivaraFP. Physician concussion knowledge and the effect of mailing the CDC’s “Heads Up” toolkit. Clin Pediatr (Phila). 2011;50:1031-1039.
33.
ByszewskiAMGrahamIDAmosS. A continuing medical education initiative for canadian primary care physicians: the driving and dementia toolkit: a pre- and postevaluation of knowledge, confidence gained, and satisfaction. J Am Geriatr Soc. 2003;51:1484-1489.
34.
HootsWKShurinSB. Future directions of sickle cell disease research: the NIH perspective. Pediatr Blood Cancer. 2012;59:353-357.
35.
OyekuSOWangCJScovilleR. Hemoglobinopathy Learning Collaborative: using quality improvement (QI) to achieve equity in health care quality, coordination, and outcomes for sickle cell disease. J Health Care Poor Underserved. 2012;23(3 suppl):34-48.
36.
SoxC. Health supervision for children with sickle cell disease. Pediatrics. 2003;111:710-711.
37.
FullertonHJGardnerMAdamsRJLoLCJohnstonSC. Obstacles to primary stroke prevention in children with sickle cell disease. Neurology. 2006;67:1098-1099.
38.
BollingerLMNireKGRhodesMMChisolmDJO’BrienSH. Caregivers’ perspectives on barriers to transcranial Doppler screening in children with sickle-cell disease. Pediatr Blood Cancer. 2011;56:99-102.
39.
TennerCTHerzogKChaudhariSBiniEJWeinshelEH. Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States. Int J Clin Pract. 2012;66:1009-1013.
40.
SheldrickRCLeslieLKRoddayAMParsonsSKSaundersTSWongJB. Variations in Physician Attitudes Regarding ADHD and Their Association With Prescribing Practices [Published online November9, 2012]. J Atten Disord. doi:10.1177/1087054712461689.
41.
BeaudinMDaughertyMGeisG. Assessment of factors associated with the delayed transfer of pediatric trauma patients: an emergency physician survey. Pediatr Emerg Care. 2012;28:758-763.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
