title: Preventive Care Delivery to Young Children With Sickle Cell Disease.
abstract: Preventive services can reduce the morbidity of sickle cell disease (SCD) in children but are delivered unreliably. We conducted a retrospective cohort study of children aged 2 to 5 years with SCD, evaluating each child for 14 months and expecting that he/she should receive ≥75% of days covered by antibiotic prophylaxis, ≥1 influenza immunization, and ≥1 transcranial Doppler ultrasound (TCD). We used logistic regression to quantify the relationship between ambulatory generalist and hematologist visits and preventive services delivery. Of 266 children meeting the inclusion criteria, 30% consistently filled prophylactic antibiotic prescriptions. Having ≥2 generalist, non-well child care visits or ≥2 hematologist visits was associated with more reliable antibiotic prophylaxis. Forty-one percent of children received ≥1 influenza immunizations. Children with ≥2 hematologist visits were most likely to be immunized (62% vs. 35% among children without a hematologist visit). Only 25% of children received ≥1 TCD. Children most likely to receive a TCD (42%) were those with ≥2 hematologist visits. One in 20 children received all 3 preventive services. Preventive services delivery to young children with SCD was inconsistent but associated with multiple visits to ambulatory providers. Better connecting children with SCD to hematologists and strengthening preventive care delivery by generalists are both essential.
authors.affiliation: *Department of Pediatrics, Division of General Pediatrics, Medical University of South Carolina, Charleston, SC Departments of †Biostatistics ¶Health Policy & Management, Johns Hopkins Bloomberg School of Public Health Departments of ‡Pediatrics, Division of Pediatric Hematology §Medicine, Division of Hematology ∥Pediatrics, Division of Quality and Safety, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: David G
authors.initials: DG
authors.lastname: Bundy
authors.forename: John
authors.initials: J
authors.lastname: Muschelli
authors.forename: Gwendolyn D
authors.initials: GD
authors.lastname: Clemens
authors.forename: John J
authors.initials: JJ
authors.lastname: Strouse
authors.forename: Richard E
authors.initials: RE
authors.lastname: Thompson
authors.forename: James F
authors.initials: JF
authors.lastname: Casella
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D000755:Anemia, Sickle Cell / Q000628:therapy*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D009819:Office Visits; D011315:Preventive Medicine / Q000379:methods*; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial