title: Emergency provider analgesic practices and attitudes toward patients with sickle cell disease.
abstract: OBJECTIVE
  We determine whether emergency provider attitudes and demographics are associated with adherence to national guidelines for the management of acute sickle cell disease pain.
  
  
  METHODS
  We conducted a cross-sectional survey of emergency providers at the 2011 annual American College of Emergency Physicians Scientific Assembly, using a validated instrument to assess provider attitudes and self-reported analgesic practices toward patients with sickle cell disease. Multivariable, relative risk regressions were used to identify factors associated with adherence to guidelines.
  
  
  RESULTS
  There were 722 eligible participants, with a 93% complete response rate. Most providers self-reported adherence to the cornerstones of sickle cell disease pain management, including parenteral opioids (90%) and redosing opioids within 30 minutes if analgesia is inadequate (85%). Self-reported adherence was lower for other recommendations, including use of patient-controlled analgesia, acetaminophen, non-steroidal anti-inflammatory drugs and hypotonic fluids for euvolemic patients. Emergency providers in the highest quartile of negative attitudes were 20% less likely to redose opioids within 30 minutes for inadequate analgesia (risk ratio 0.8; 95% confidence interval [CI] 0.7 to 0.9). High-volume providers (those who treat more than 1 sickle cell disease patient per week), were less likely to redose opioids within 30 minutes for inadequate analgesia (risk ratio 0.9; 95% CI 0.8 to 0.9). Pediatric providers were 6.6 times more likely to use patient-controlled analgesia for analgesia (95% CI 2.6 to 16.6).
  
  
  CONCLUSIONS
  The majority of emergency providers report that they adhere to national guidelines about use of opioids for sickle cell disease-related acute pain episodes. Other recommendations have less penetration. Negative attitudes toward individuals with sickle cell disease are associated with lower adherence to guidelines.
authors.affiliation: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. Electronic address: jeffreyglassberg@gmail.com.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Glassberg
authors.forename: Paula
authors.initials: P
authors.lastname: Tanabe
authors.forename: Annie
authors.initials: A
authors.lastname: Chow
authors.forename: Katrina
authors.initials: K
authors.lastname: Harper
authors.forename: Carlton
authors.initials: C
authors.lastname: Haywood
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
authors.forename: Lynne D
authors.initials: LD
authors.lastname: Richardson
mesh_terms: D059787:Acute Pain / Q000188:drug therapy; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000523:psychology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
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