Physicians' perceptions of factors influencing adherence to antibiotic prophylaxis in children with sickle cell disease.

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.