Direct mail does not improve screening in sickle cell disease

Abstract

Because children with sickle cell disease have an increased risk for stroke, annual transcranial Doppler (TCD) screening is recommended for children diagnosed with sickle cell disease from ages 2 to 16 years, yet implementation has been limited. Can letters mailed directly to parents and primary providers improve compliance? To investigate this, Bundy et al mailed reminders to families and primary doctors of eligible children in one Medicaid managed care organization, and compared results with 6 other Medicaid managed care organizations serving as controls. There was no difference in screening rates following the intervention, and less than 10% of unscreened individuals in either group underwent TCD screening. This very low rate of compliance is discouraging. Although direct mail might work for marketing, such does not improve screening compliance in sickle cell disease. Other ways to increased TCD screening are needed if we aim to identify candidates for chronic blood transfusions or hydroxyurea and hope to prevent strokes in patients with sickle cell disease. Article page 188▶ Transcranial Doppler Screening of Medicaid-Insured Children with Sickle Cell DiseaseThe Journal of PediatricsVol. 166Issue 1PreviewTranscranial Doppler screening reduces the risk of stroke in children with sickle cell disease. We tested the effect of informational letters sent to parents and doctors of Medicaid-insured children on improving screening efficiency. The letters did not improve the low baseline screening rates, suggesting the need for more aggressive outreach. Hematologist visits were correlated with increased screening rates. Full-Text PDF