Assessment of care of children with sickle cell disease: implications for neonatal screening programmes.
OBJECTIVE
To assess the quality of care provided by hospitals for young children with sickle cell disease.


METHODS
Retrospective survey.


METHODS
Teaching hospital in London.


METHODS
31 Children (mean age 4 years 4 months, range 4 months to 7 years 5 months) born with sickle cell disease between 1978 and 1985 identified from Hospital Activity Analysis data, an outpatient diagnostic register, and registers of the haematology department. Eight had been diagnosed on neonatal screening and at least four of these had not been followed up.


METHODS
Aspects of quality of outpatient care (blood testing, clinic attendance, and prophylactic drug treatment) and family care (adequate support and carers' knowledge about the disease) as assessed by reviewing the notes and administering a semistructured questionnaire to the carers, in relation to a devised list of standards deemed necessary to ensure achievement of the aims of screening.


RESULTS
There were 93 outpatient attendances during the previous 12 months, but 13 children had not attended at least every six months and four not at all for more than a year. Only eight children had had three of the blood tests considered to be necessary for good care; three had had none. Prophylactic treatment with penicillin and folic acid was erratic; three children with sickle cell anaemia were not receiving regular prophylactic penicillin.


CONCLUSIONS
Diagnosis of sickle cell disease on neonatal screening must be linked with follow up to ensure optimal management.
Milne
R I
RI
Department of Community Medicine, United Medical School, Guy's Hospital, London.
D000755:Anemia, Sickle Cell / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001294:Attitude to Health; D002648:Child; D002662:Child Health Services / Q000592:standards; D002675:Child, Preschool; D006801:Humans; D007231:Infant, Newborn; D008131:London; D015997:Neonatal Screening; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010349:Patient Compliance; D011787:Quality of Health Care; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents