Barriers to Pediatric Sickle Cell Disease Guideline Recommendations

Michael D. Cabana, Julie Kanter, Anne M. Marsh, Marsha J. Treadwell, Michael Rowland, Peggy Stemmler, Naomi S. Bardach

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


National guidelines recommend that providers counsel all patients with sickle cell anemia about hydroxyurea (HU) therapy and screen children with sickle cell anemia annually for the risk of stroke with transcranial Doppler (TCD). We surveyed a national convenience sample of sickle cell disease clinicians to assess factors associated with low adherence. Adherence was 46% for TCD screening. Low adherence was associated with a lack of outcome expectancy (eg, a belief that there would be poor patient follow-up to TCD testing; P <.05). Adherence was 72% for HU counseling. Practice barriers (eg, lack of support staff or time) and a lack of agreement with HU recommendations were associated with low adherence (P <.05). This study demonstrates that different types of strategies are needed to improve TCD screening (to address follow-up and access to testing) versus HU counseling (to address physician agreement and practice barriers).

Original languageEnglish (US)
JournalGlobal Pediatric Health
StatePublished - 2019
Externally publishedYes


  • adherence
  • clinical practice guidelines
  • physician practice patterns

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pediatrics


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