International Journal for Quality in Health Care 16:245-251 (2004)
International Journal for Quality in Health Care vol. 16 no. 3 © International Society for Quality in Health Care and Oxford University Press 2004; all rights reserved
Physician knowledge and adherence to prescribing antibiotic prophylaxis for sickle cell disease
University of North Carolina School of Pharmacy and School of Public Health, University of North Carolina, Chapel Hill, NC, USA
Objective. The purpose of this research was to examine how physician characteristics were associated with: (i) physician knowledge of and adherence to sickle cell guidelines; and (ii) the types of educational programs about sickle cell disease desired by physicians.
Methods. A survey was developed to assess the research objective. After the survey was pre-tested and an institutional review board exemption was obtained, it was sent to a systematic random sample of 375 pediatricians and all 125 practicing hematologists in North Carolina. They were asked to answer a six-item knowledge test relating to the antibiotic prophylaxis guidelines.
Results. The response rate was 57%, of which 61% were pediatricians. Over half (56%) were in a practice with at least one pediatric sickle cell patient. Fifty-nine percent of physicians answered five or more questions correctly on the knowledge test. The question most physicians answered correctly (97%) pertained to the necessity of antibiotics for children with sickle cell disease. The question most frequently answered incorrectly (62%) pertained to prescribing antibiotics to a child with unconfirmed sickle cell disease. Logistic regression results indicated that the number of sickle cell patients seen in practice influenced the number of questions answered correctly. Sixty-six percent of physicians prescribed prophylactic antibiotics for 100% of their patients with sickle cell disease and therefore were 100% adherent. Eighty-one percent of pediatricians compared with 12% of hematologists were 100% adherent in prescribing antibiotics. Hematologists and those practicing at a medical school or university were less likely to be 100% adherent in prescribing antibiotic prophylaxis.
Conclusion. The majority of physicians surveyed were relatively knowledgeable about sickle cell guidelines, however there may be a need for continuing education programs that focus on the issues of prescribing antibiotics to a child with unconfirmed sickle cell disease and penicillin dosage.
Keywords: antibiotic prophylaxis, continuing education, physician adherence, physician knowledge, sickle cell disease
Address reprint requests to Keele E. Wurst, University of North Carolina at Chapel Hill, School of Pharmacy, Beard Hall, CB #7630, Chapel Hill, NC 27599-7630, USA. E-mail: keele_wurst{at}unc.edu or keelevan{at}email.unc.edu
Accepted for publication December 10, 2003.
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