Physician Attitude, Awareness, and Knowledge Regarding Guidelines for Transcranial Doppler Screening in Sickle Cell Disease

Reeves, Sarah L.; Fullerton, Heather J.; Dombkowski, Kevin J.; Boulton, Matthew L.; Braun, Thomas; Lisabeth, Lynda D.

doi:10.1177/0009922814553429

Cited by 21 publications

(24 citation statements)

References 40 publications

(49 reference statements)

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“…47 We hypothesized that hematologist visits would spur TCD delivery based on published evidence suggesting greater awareness of TCD guidelines, self-efficacy regarding discussing TCDs with patients and families, and overall TCD knowledge among pediatric hematologists, compared with generalists. 48 Unfortunately, patient-related barriers to TCD screening may dampen positive effects of physician contact. In one study of 36 caregivers of children with SCD, 22% had no knowledge of TCD screening and another 42% did not know TCD screening was annual.…”

Section: Discussionmentioning

confidence: 99%

Preventive Care Delivery to Young Children With Sickle Cell Disease

Bundy

Muschelli

Clemens

et al. 2016

Journal of Pediatric Hematology/Oncology

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Preventive services can reduce the morbidity of sickle cell disease (SCD) in children but are delivered unreliably. We conducted a retrospective cohort study of children ages 2–5 years with SCD, evaluating each child for 14 months and expecting that he/she should receive ≥75% of days covered by antibiotic prophylaxis, ≥1 influenza immunization, and ≥1 transcranial Doppler ultrasound (TCD). We used logistic regression to quantify the relationship between ambulatory generalist and hematologist visits and preventive services delivery. Of 266 children meeting inclusion criteria, 30% consistently filled prophylactic antibiotic prescriptions. Having ≥2 generalist, non-well child care visits or ≥2 hematologist visits was associated with more reliable antibiotic prophylaxis. Forty-one percent of children received ≥1 influenza immunizations. Children with ≥2 hematologist visits were most likely to be immunized (62% versus 35% among children without a hematologist visit). Only 25% of children received ≥1 TCD. Children most likely to receive a TCD (42%) were those with ≥2 hematologist visits. One in twenty children received all three preventive services. Preventive services delivery to young children with SCD was inconsistent but associated with multiple visits to ambulatory providers. Better connecting children with SCD to hematologists and strengthening preventive care delivery by generalists are both essential.

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Section: Discussionmentioning

confidence: 99%

Preventive Care Delivery to Young Children With Sickle Cell Disease

Bundy

Muschelli

Clemens

et al. 2016

Journal of Pediatric Hematology/Oncology

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“…Lack of knowledge and/or awareness regarding TCD screening guidelines among physicians could be contributing to underrecommendation for TCD screening and, therefore, missed opportunities. 30,31 Patient barriers such as distance to a TCD screening facility and appointment adherence could also play a role in receipt of TCD screening, regardless of physician recommendation. 15,16,32 Furthermore, caregivers of children with SCD have been shown to perceive the stroke risk for their child to be low and may not realize the importance of TCD screening.…”

Section: Discussionmentioning

confidence: 99%

Missed Opportunities for Transcranial Doppler Screening Among Children With Sickle Cell Disease

Reeves

Fullerton

Cohn

et al. 2016

Clin Pediatr (Phila)

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Transcranial Doppler (TCD) screening rates remain low among children with sickle cell disease (SCD). We assessed TCD screening rates and missed opportunities for TCD screening. Children 2 to 16 years old with SCD enrolled in Michigan Medicaid for ≥1 year (2007-2011) were identified through newborn screening. Receipt of TCD screening and presence of a missed opportunity (≥1 SCD-related outpatient visit, no TCD screening) were identified through administrative claims. Potential correlates of missed opportunities included SCD-related health services, comorbidities, and demographics. Logistic regression with generalized estimating equations modeled associations between a missed opportunity and correlates. Overall, 353 children contributed 1066 person-years. TCD screening was low yearly (10%-32%); missed opportunities occurred in 73% of the person-years. Increasing age (odds ratio [OR] = 1.11; confidence interval CI = 1.07, 1.15), previous TCD screening (OR = 0.26; CI = 0.16, 0.41), and 4 to 5 (OR = 0.48; CI = 0.26, 0.87) or ≥6 outpatient visits (OR = 0.26; CI = 0.14, 0.49) were associated with a missed opportunity. Reduction of missed opportunities is a potential strategy to increase TCD screening rates.

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“…As such, education of primary care physicians in the importance of these preventive services is necessary. 32 Patient and parentfocused interventions may be most effective when focused on family and social factors that may impact receipt of filled prescriptions at the pharmacy and administration of the antibiotics to the child. For example, the typical formulation of prophylactic antibiotics requires that refills be obtained frequently given the limited shelf life.…”

Section: Figurementioning

confidence: 99%