Wurst Keele E, Sleath Betsy L, Konrad Thomas R
Schools of Pharmacy and Public Health, and.
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.
Curr Ther Res Clin Exp. 2003 Feb;64(2):116-26. doi: 10.1016/S0011-393X(03)00016-X.
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.
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.
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.
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.
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.
小于5岁的镰状细胞病（SCD）患儿因脾脏无法抵御感染，面临感染肺炎链球菌和流感嗜血杆菌的高风险。
本研究调查了（1）医生对SCD患儿抗生素预防性治疗依从性相关因素的看法，以及（2）医生特征与这些看法之间的关联。
利用医学主题词表（MEDLINE）检索1996年至2002年期间，使用了镰状细胞病、依从性、儿童、医生看法和抗生素预防性治疗等检索词。基于现有文献设计了一项调查，以评估医生对SCD患儿抗生素预防性治疗依从性相关因素的看法。该调查被发送给北卡罗来纳州375名儿科医生和所有125名执业血液科医生的分层随机样本。他们使用李克特量表来评估他们对影响SCD患儿抗生素预防性治疗依从性因素的看法。使用北卡罗来纳州卫生专业人员数据库收集医生的人口统计学信息。将人口统计学信息与调查受访者进行匹配，并与他们的回答相关联。
回复率为56.9%。在受访者中，60.9%是儿科医生，56.5%所在的医疗机构中至少有1名小于5岁的SCD患儿。医生的种族和执业专业与医生认为对依从性非常重要的因素显著相关。
大多数医生在影响依从性的许多问题上意见一致；然而，基于医生种族存在显著且重要的差异。本研究中医生对影响依从性因素的看法并不总是与已证明实际影响SCD患者依从性的因素一致。因此，本研究表明需要开展针对实际影响抗生素预防性治疗依从性的因素以及医疗服务提供者与患者种族/民族背景关系的医生继续教育项目。
