PRIMARY HEALTH CARE AND GENERAL PRACTICE
Healthcare provider knowledge, attitudes and practices in patients on the Victorian Spleen Registry Anneke Graf,1 Penelope Jones,1 Allen C. Cheng,1,2 Karin Leder1,2
A
splenic and hyposplenic patients are at an increased risk of infections, particularly overwhelming postsplenectomy sepsis.1,2 Previous studies suggest that adherence to preventive measures, including the use of prophylactic antibiotics, immunisation and contingency plans/emergency antibiotics, is poor among asplenic patients.1,3 This may reflect a lack of awareness of recommended measures by medical professionals caring for patients, as well as poor patient education.
Abstract Objective: This study aimed to evaluate the knowledge, attitudes and practices of healthcare providers regarding asplenic patients and to assess their satisfaction with the Victorian Spleen Registry (VSR) service. Methods: Survey forms were sent to 992 healthcare providers listed as caring for at least one patient registered on the VSR.
The Victorian Spleen Registry (VSR) provides patient and provider education about prevention of infections, including risk assessment, immunisation and antibiotic prophylaxis. The VSR was an initiative of The Alfred Hospital Infectious Diseases Unit and commenced recruitment in December 2003, after receiving Victorian Department of Health funding. The patient at registration receives an individualised vaccination card and VSR report, along with alert cards, patient information sheets and an annual newsletter. Their healthcare provider also receives the VSR report, VSR recommendations and a newsletter. The VSR also acts to disseminate current vaccination guidelines and answers queries from both patients and healthcare providers. Since March 2010, a website (www. spleen.org.au) has also been established providing additional information. In May 2012, the VSR had 2573 registered patients and was receiving approximately 40 new referrals each month predominantly from patients residing in Victoria. We aimed to evaluate the knowledge, attitudes and practices of healthcare providers regarding
Results: A total of 223 completed questionnaires were returned. Healthcare providers heard about the VSR mainly from another healthcare professional or through a healthcare institution (31.7%), via online or printed resources (30.8%) or from their patients (24.4%). Most respondents valued the work of the VSR in providing information to healthcare professionals (71.4%), providing a reminder service for vaccinations (66.7%) and providing education to patients (60.5%). Most of those surveyed correctly identified high-risk infections for asplenic and hyposplenic patients with encapsulated organisms, but less than one-third identified a risk with malarial infections (32.9%). Providers always recommended influenza vaccinations, emergency standby antibiotics and an alert medallion or card in 92.8%, 63.6% and 36.4% of cases, respectively. Conclusions: Healthcare providers value and are satisfied with the service provided by the VSR. Patients can play a valuable role in communicating with their health providers. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. Implications: The results positively reflect the functioning of the VSR, although better promotion of the VSR among healthcare professionals and consideration of expansion is needed. Key words: Spleen registry; healthcare provider; survey; asplenic; hyposplenic. asplenic patients, as well as assessing their satisfaction with the VSR service.
Methods In May 2012, a survey was sent to 992 healthcare professionals. These medical practitioners were listed as caring for at least one patient registered on the VSR, and were either general practitioners or referring hospital-based doctors. If the medical practitioner belonged to a group clinic
only one survey was sent to the practice. A paper-based survey, along with a replied paid envelope, was mailed accompanying the annual VSR newsletter. The survey could be optionally completed through a webbased survey tool. Alternative addresses were sought for any returned unanswered surveys, and a second survey was sent in July to nonrespondents. The 20-question survey examined the provider’s prior experience with the VSR,
1. Victorian Spleen Registry, Infectious Diseases Unit, The Alfred Hospital, Victoria 2. Department of Epidemiology and Preventive Medicine, Monash University, Victoria Correspondence to: Ms Penelope Jones, Victorian Spleen Registry, 2nd Floor Burnet Building, 85 Commercial Road, Melbourne, Victoria 3004; e-mail: [email protected] Submitted: December 2013; Revision requested: January 2014; Accepted: February 2014 The authors have stated the following conflict of interest: Penelope Jones is employed as manager of the Victorian Spleen Registry. Aust NZ J Public Health. 2014; 38:560-2; doi: 10.1111/1753-6405.12242
560
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
2014 vol. 38 no. 6
Primary Health Care and General Practice
their attitude towards this service, their knowledge of current VSR guidelines and their current management practices with asplenic or hyposplenic patients. The questionnaire included a mix of multiple choice and open-ended text responses. Data from surveys returned prior to 1 October 2012 were examined. The activities of the VSR are covered by Alfred Health Human Research Ethics Committee, approval number HREC 189/07. Ethics approval was not sought specifically for this project, as healthcare providers had the option of completing the survey anonymously and participation was voluntary. Respondents provided implicit consent by returning the questionnaire. Results of the survey were published in the VSR newsletter, which was sent to the same group of healthcare professionals.
Results Of the 992 surveys sent, 223 surveys were returned to the VSR (22.5% response rate); a mailing address was not found for six practitioners and the remainder did not respond. Most responses were completed by general practitioners (n=170), with other respondents including hospital-based doctors (n=36) and other health professionals (mainly general practice nurses or hospital pharmacists; n=17). The majority of healthcare providers first heard about the VSR from another healthcare professional or through a healthcare institution (31.7%), via online or printed resources (30.8%), or from their patients (24.4%). Just over half the providers had registered 1–4 asplenic or hyposplenic patients (51.8%). Most providers recalled having previously received information from the VSR (77.1%), predominantly the VSR guidelines (47.7%), see Table 1. The majority of survey participants had not visited the VSR website (72.0%). Of the 35.8% of healthcare providers who had directly contacted the VSR staff, this was mostly via phone (90.9%). Most providers felt information received from the VSR did not conflict with information from other sources (92.0%). Almost all providers had no difficulties registering patients (95.0%). The majority rated the level of communication between the VSR and healthcare professionals, the quality of the information from the VSR, the accessibility of VSR resources and the overall management of patients as ‘excellent’ or ‘good’. Most respondents valued the work of the VSR
2014 vol. 38 no. 6
A survey to evaluate the Victorian Spleen Registry
in providing information to healthcare professionals (71.4%), providing a reminder service for vaccinations (66.7%) and providing education to patients (60.5%). A common suggestion to improve patient registration with the VSR was to increase self-promotion and exposure to patients and healthcare professionals (40.7%), and consideration of expansion to a nationwide service (19.1%). Other notable suggestions included promoting the VSR service in general practitioner and nurse magazines, and adding the guidelines to the Australian Immunisation Handbook. The majority of those surveyed correctly identified high-risk infections for asplenic and hyposplenic patients from encapulsated organisms (pneumococcus, meningococcus and Haemophilus influenza Type B) but only 32.9% identified a risk with malarial infection (see Table 1). Influenza vaccination was always recommended by 92.8% of providers, and emergency standby antibiotics were recommended to all patients in 63.6% and to selected patients in a further 27.7%. Providers were evenly divided on recommending alert medallion or alert card to indicate asplenic or hyposplenic status, with 36.4% ‘always’, 33.6%
‘sometimes’ and 30.0% ‘never’ recommending this (see Table 1).
Discussion The VSR was established to provide information to patients and their healthcare providers regarding optimal management post-splenectomy or for patients with hyposplenism. Overall, among responders, attitudes towards to the VSR activities were positive. The broad spread in the avenues by which healthcare providers had first heard about the VSR reinforces the need for multiple modes of communication to further promote this service, including additional promotion of the VSR website and the recent addition of software to enable online registration of patients. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. Also notable was that more than one-third of surveyed healthcare providers had contacted the VSR for information, suggesting a significant demand for credible and accessible information regarding management of splenectomised individuals.
Table 1: Three sample questions and results from the survey. Interaction with the VSR
Response percent (multiple answers allowed)
Have you ever received any of the following from the VSR? VSR recommendations for asplenic, hyposplenic or splenic embolisations
47.7%
Annual VSR newsletter
38.3%
VSR patient registration form
32.2%
Information about the VSR’s website
26.2%
VSR patient information sheet on splenic function and hyposplenism
22.4%
Individualised VSR report for a specific patient
38.8%
Not received anything Knowledge
22.9% Response percent (multiple answers allowed)
Which of the following infections do you consider to be particularly high risk in asplenic or hyposplenic patients? Staphylococcal sepsis
27.9%
a
Pneumococcal sepsis
97.3%
Meningococcal sepsisa
86.8%
E. coli
15.1%
Haemophilus influenzae Type B (Hib)a Malaria
81.7%
a
Management
32.9% Response percent
In your management of asplenic or hyposplenic patients, do you recommend:
Always
Sometimes
Never
Annual influenza vaccination?
92.8%
5.4%
1.8%
Emergency or standby antibiotics?
63.6%
27.7%
8.6%
MedicAlert medallion or alert card?
36.4%
33.6%
30.0%
a. correct answer
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
561
Graf et al.
Article
Almost one-quarter of health professionals had first heard about the VSR from a patient, demonstrating that patients can play a valuable role in communicating with their healthcare providers. Responding health professionals seemed generally aware of the need for asplenic and hyposplenic patients to have an annual influenza vaccine. Most providers were aware of the high-risk infections these patients may face, although many did not seem aware of the increased risk of malarial infection. Awareness regarding the need for vaccination and prophylactic antibiotics was higher than that reported in a Dutch survey, where 37.0% and 71.7% of general practitioners reported being unfamiliar with recommended immunisation and antibiotics for asplenic patients, respectively.4 Recommendations for an emergency course of antibiotics and medical alert bracelets was higher than in a survey of 122 Canadian physicians, who recommended these to only 7.8% and 28.8% of their patients, respectively.5 There appears to be good communication between the VSR, hospital-based specialists and general practitioners. Feedback reflected that the VSR generally did not conflict with information from other sources. The VSR overcomes several barriers identified by the Dutch survey of healthcare providers caring for asplenic patients, including poor patient knowledge and mistrust of recommendations in discharge summaries.4 Suggestions for improvements that were noted included the need to increase promotion and exposure of the VSR to patients and healthcare professionals. Between 2003 and May 2012, 2,415 patients had been registered with the VSR service with a combined duration of follow-up of 6,504 patient years. We are only aware of one patient who had an overwhelming post-splenectomy infection (OPSI) after registration. We are not aware of similar registries of asplenic patients elsewhere. A regional UK registry acted primarily as an antibody level monitoring service in a two-year pilot program, although it also disseminated guidelines and provided
562
information to patients.6 Another small registry of 75 patients has been developed at an American general medicine practice, which has created guidelines for physician education, offers a vaccinations service and has developed an outreach program for asplenic patient education.7 A regional initiative in the UK undertook active case finding from hospital and general practice records to identify asplenic patients and offer them preventive measures, but does not seem to have been developed into an ongoing registry.8 The main limitation of this study was the poor response rate, despite two contact attempts. It is possible that those practitioners who were less familiar with recommendations for management of asplenic patients did not respond. This potentially biases the study results and limits generalisability.
Conclusion and implications The VSR fulfils an important function in providing information to patients and healthcare providers. This survey suggests that healthcare providers value the service provided, with respondents noting its functions in patient and provider education and vaccine reminders, and one-third contacting the VSR for advice. Patients can play a valuable role in communicating with their health providers. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. Overall, the results reflect positively regarding the functioning of the VSR, although better promotion of the service among healthcare professionals and consideration of expansion is needed.
Acknowledgements This project was funded by The Syd and Ann Wellard Perpetual Trust, a philanthropic organisation, who had no input into the design, conduct or analysis of the survey.
References 1. Waghorn DJ. Overwhelming infection in asplenic patients: Current best practice preventive measures are not being followed. J Clin Pathol. 2001;54:214–18. 2. Spelman D, Buttery J, Daley A, Isaacs D, Jennens I, Kakakios A, et al. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med. 2008;38:349–56. 3. de Montalembert M, Lenoir G. Antibiotic prevention of pneumococcal infections in asplenic hosts: Admission of insufficiency. Ann Hematol. 2004;83:18–21. 4. Lammers AJ, Hoekstra JB, Speelman P, Lombarts KM. Physicians report barriers to deliver best practice care for asplenic patients: A cross-sectional survey. PLoS One. 2011;6(3):e17302. 5. Brigden ML, Pattullo A, Brown G. Practising physician’s knowledge and patterns of practice regarding the asplenic state: The need for improved education and a practical checklist. Can J Surg. 2001;44:210-16. 6. Spickett GP, Bullimore J, Wallis J, Smith S, Saunders P. Northern region asplenia register-analysis of first two years. J Clin Pathol. 1999;52:424-9. 7. Kim HS, Kriegel G, Aronson MD. Improving the preventive care of asplenic patients. Am J Med. 2012;125:454-6. 8. Sarangi J, Coleby M, Trivella M, Reilly S. Prevention of post-splenectomy sepsis: A population based approach. J Public Health Med. 1997;19:208–12.
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
2014 vol. 38 no. 6
Healthcare provider knowledge, attitudes and practices in patients on the Victorian Spleen Registry Anneke Graf,1 Penelope Jones,1 Allen C. Cheng,1,2 Karin Leder1,2
A
splenic and hyposplenic patients are at an increased risk of infections, particularly overwhelming postsplenectomy sepsis.1,2 Previous studies suggest that adherence to preventive measures, including the use of prophylactic antibiotics, immunisation and contingency plans/emergency antibiotics, is poor among asplenic patients.1,3 This may reflect a lack of awareness of recommended measures by medical professionals caring for patients, as well as poor patient education.
Abstract Objective: This study aimed to evaluate the knowledge, attitudes and practices of healthcare providers regarding asplenic patients and to assess their satisfaction with the Victorian Spleen Registry (VSR) service. Methods: Survey forms were sent to 992 healthcare providers listed as caring for at least one patient registered on the VSR.
The Victorian Spleen Registry (VSR) provides patient and provider education about prevention of infections, including risk assessment, immunisation and antibiotic prophylaxis. The VSR was an initiative of The Alfred Hospital Infectious Diseases Unit and commenced recruitment in December 2003, after receiving Victorian Department of Health funding. The patient at registration receives an individualised vaccination card and VSR report, along with alert cards, patient information sheets and an annual newsletter. Their healthcare provider also receives the VSR report, VSR recommendations and a newsletter. The VSR also acts to disseminate current vaccination guidelines and answers queries from both patients and healthcare providers. Since March 2010, a website (www. spleen.org.au) has also been established providing additional information. In May 2012, the VSR had 2573 registered patients and was receiving approximately 40 new referrals each month predominantly from patients residing in Victoria. We aimed to evaluate the knowledge, attitudes and practices of healthcare providers regarding
Results: A total of 223 completed questionnaires were returned. Healthcare providers heard about the VSR mainly from another healthcare professional or through a healthcare institution (31.7%), via online or printed resources (30.8%) or from their patients (24.4%). Most respondents valued the work of the VSR in providing information to healthcare professionals (71.4%), providing a reminder service for vaccinations (66.7%) and providing education to patients (60.5%). Most of those surveyed correctly identified high-risk infections for asplenic and hyposplenic patients with encapsulated organisms, but less than one-third identified a risk with malarial infections (32.9%). Providers always recommended influenza vaccinations, emergency standby antibiotics and an alert medallion or card in 92.8%, 63.6% and 36.4% of cases, respectively. Conclusions: Healthcare providers value and are satisfied with the service provided by the VSR. Patients can play a valuable role in communicating with their health providers. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. Implications: The results positively reflect the functioning of the VSR, although better promotion of the VSR among healthcare professionals and consideration of expansion is needed. Key words: Spleen registry; healthcare provider; survey; asplenic; hyposplenic. asplenic patients, as well as assessing their satisfaction with the VSR service.
Methods In May 2012, a survey was sent to 992 healthcare professionals. These medical practitioners were listed as caring for at least one patient registered on the VSR, and were either general practitioners or referring hospital-based doctors. If the medical practitioner belonged to a group clinic
only one survey was sent to the practice. A paper-based survey, along with a replied paid envelope, was mailed accompanying the annual VSR newsletter. The survey could be optionally completed through a webbased survey tool. Alternative addresses were sought for any returned unanswered surveys, and a second survey was sent in July to nonrespondents. The 20-question survey examined the provider’s prior experience with the VSR,
1. Victorian Spleen Registry, Infectious Diseases Unit, The Alfred Hospital, Victoria 2. Department of Epidemiology and Preventive Medicine, Monash University, Victoria Correspondence to: Ms Penelope Jones, Victorian Spleen Registry, 2nd Floor Burnet Building, 85 Commercial Road, Melbourne, Victoria 3004; e-mail: [email protected] Submitted: December 2013; Revision requested: January 2014; Accepted: February 2014 The authors have stated the following conflict of interest: Penelope Jones is employed as manager of the Victorian Spleen Registry. Aust NZ J Public Health. 2014; 38:560-2; doi: 10.1111/1753-6405.12242
560
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
2014 vol. 38 no. 6
Primary Health Care and General Practice
their attitude towards this service, their knowledge of current VSR guidelines and their current management practices with asplenic or hyposplenic patients. The questionnaire included a mix of multiple choice and open-ended text responses. Data from surveys returned prior to 1 October 2012 were examined. The activities of the VSR are covered by Alfred Health Human Research Ethics Committee, approval number HREC 189/07. Ethics approval was not sought specifically for this project, as healthcare providers had the option of completing the survey anonymously and participation was voluntary. Respondents provided implicit consent by returning the questionnaire. Results of the survey were published in the VSR newsletter, which was sent to the same group of healthcare professionals.
Results Of the 992 surveys sent, 223 surveys were returned to the VSR (22.5% response rate); a mailing address was not found for six practitioners and the remainder did not respond. Most responses were completed by general practitioners (n=170), with other respondents including hospital-based doctors (n=36) and other health professionals (mainly general practice nurses or hospital pharmacists; n=17). The majority of healthcare providers first heard about the VSR from another healthcare professional or through a healthcare institution (31.7%), via online or printed resources (30.8%), or from their patients (24.4%). Just over half the providers had registered 1–4 asplenic or hyposplenic patients (51.8%). Most providers recalled having previously received information from the VSR (77.1%), predominantly the VSR guidelines (47.7%), see Table 1. The majority of survey participants had not visited the VSR website (72.0%). Of the 35.8% of healthcare providers who had directly contacted the VSR staff, this was mostly via phone (90.9%). Most providers felt information received from the VSR did not conflict with information from other sources (92.0%). Almost all providers had no difficulties registering patients (95.0%). The majority rated the level of communication between the VSR and healthcare professionals, the quality of the information from the VSR, the accessibility of VSR resources and the overall management of patients as ‘excellent’ or ‘good’. Most respondents valued the work of the VSR
2014 vol. 38 no. 6
A survey to evaluate the Victorian Spleen Registry
in providing information to healthcare professionals (71.4%), providing a reminder service for vaccinations (66.7%) and providing education to patients (60.5%). A common suggestion to improve patient registration with the VSR was to increase self-promotion and exposure to patients and healthcare professionals (40.7%), and consideration of expansion to a nationwide service (19.1%). Other notable suggestions included promoting the VSR service in general practitioner and nurse magazines, and adding the guidelines to the Australian Immunisation Handbook. The majority of those surveyed correctly identified high-risk infections for asplenic and hyposplenic patients from encapulsated organisms (pneumococcus, meningococcus and Haemophilus influenza Type B) but only 32.9% identified a risk with malarial infection (see Table 1). Influenza vaccination was always recommended by 92.8% of providers, and emergency standby antibiotics were recommended to all patients in 63.6% and to selected patients in a further 27.7%. Providers were evenly divided on recommending alert medallion or alert card to indicate asplenic or hyposplenic status, with 36.4% ‘always’, 33.6%
‘sometimes’ and 30.0% ‘never’ recommending this (see Table 1).
Discussion The VSR was established to provide information to patients and their healthcare providers regarding optimal management post-splenectomy or for patients with hyposplenism. Overall, among responders, attitudes towards to the VSR activities were positive. The broad spread in the avenues by which healthcare providers had first heard about the VSR reinforces the need for multiple modes of communication to further promote this service, including additional promotion of the VSR website and the recent addition of software to enable online registration of patients. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. Also notable was that more than one-third of surveyed healthcare providers had contacted the VSR for information, suggesting a significant demand for credible and accessible information regarding management of splenectomised individuals.
Table 1: Three sample questions and results from the survey. Interaction with the VSR
Response percent (multiple answers allowed)
Have you ever received any of the following from the VSR? VSR recommendations for asplenic, hyposplenic or splenic embolisations
47.7%
Annual VSR newsletter
38.3%
VSR patient registration form
32.2%
Information about the VSR’s website
26.2%
VSR patient information sheet on splenic function and hyposplenism
22.4%
Individualised VSR report for a specific patient
38.8%
Not received anything Knowledge
22.9% Response percent (multiple answers allowed)
Which of the following infections do you consider to be particularly high risk in asplenic or hyposplenic patients? Staphylococcal sepsis
27.9%
a
Pneumococcal sepsis
97.3%
Meningococcal sepsisa
86.8%
E. coli
15.1%
Haemophilus influenzae Type B (Hib)a Malaria
81.7%
a
Management
32.9% Response percent
In your management of asplenic or hyposplenic patients, do you recommend:
Always
Sometimes
Never
Annual influenza vaccination?
92.8%
5.4%
1.8%
Emergency or standby antibiotics?
63.6%
27.7%
8.6%
MedicAlert medallion or alert card?
36.4%
33.6%
30.0%
a. correct answer
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
561
Graf et al.
Article
Almost one-quarter of health professionals had first heard about the VSR from a patient, demonstrating that patients can play a valuable role in communicating with their healthcare providers. Responding health professionals seemed generally aware of the need for asplenic and hyposplenic patients to have an annual influenza vaccine. Most providers were aware of the high-risk infections these patients may face, although many did not seem aware of the increased risk of malarial infection. Awareness regarding the need for vaccination and prophylactic antibiotics was higher than that reported in a Dutch survey, where 37.0% and 71.7% of general practitioners reported being unfamiliar with recommended immunisation and antibiotics for asplenic patients, respectively.4 Recommendations for an emergency course of antibiotics and medical alert bracelets was higher than in a survey of 122 Canadian physicians, who recommended these to only 7.8% and 28.8% of their patients, respectively.5 There appears to be good communication between the VSR, hospital-based specialists and general practitioners. Feedback reflected that the VSR generally did not conflict with information from other sources. The VSR overcomes several barriers identified by the Dutch survey of healthcare providers caring for asplenic patients, including poor patient knowledge and mistrust of recommendations in discharge summaries.4 Suggestions for improvements that were noted included the need to increase promotion and exposure of the VSR to patients and healthcare professionals. Between 2003 and May 2012, 2,415 patients had been registered with the VSR service with a combined duration of follow-up of 6,504 patient years. We are only aware of one patient who had an overwhelming post-splenectomy infection (OPSI) after registration. We are not aware of similar registries of asplenic patients elsewhere. A regional UK registry acted primarily as an antibody level monitoring service in a two-year pilot program, although it also disseminated guidelines and provided
562
information to patients.6 Another small registry of 75 patients has been developed at an American general medicine practice, which has created guidelines for physician education, offers a vaccinations service and has developed an outreach program for asplenic patient education.7 A regional initiative in the UK undertook active case finding from hospital and general practice records to identify asplenic patients and offer them preventive measures, but does not seem to have been developed into an ongoing registry.8 The main limitation of this study was the poor response rate, despite two contact attempts. It is possible that those practitioners who were less familiar with recommendations for management of asplenic patients did not respond. This potentially biases the study results and limits generalisability.
Conclusion and implications The VSR fulfils an important function in providing information to patients and healthcare providers. This survey suggests that healthcare providers value the service provided, with respondents noting its functions in patient and provider education and vaccine reminders, and one-third contacting the VSR for advice. Patients can play a valuable role in communicating with their health providers. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. Overall, the results reflect positively regarding the functioning of the VSR, although better promotion of the service among healthcare professionals and consideration of expansion is needed.
Acknowledgements This project was funded by The Syd and Ann Wellard Perpetual Trust, a philanthropic organisation, who had no input into the design, conduct or analysis of the survey.
References 1. Waghorn DJ. Overwhelming infection in asplenic patients: Current best practice preventive measures are not being followed. J Clin Pathol. 2001;54:214–18. 2. Spelman D, Buttery J, Daley A, Isaacs D, Jennens I, Kakakios A, et al. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med. 2008;38:349–56. 3. de Montalembert M, Lenoir G. Antibiotic prevention of pneumococcal infections in asplenic hosts: Admission of insufficiency. Ann Hematol. 2004;83:18–21. 4. Lammers AJ, Hoekstra JB, Speelman P, Lombarts KM. Physicians report barriers to deliver best practice care for asplenic patients: A cross-sectional survey. PLoS One. 2011;6(3):e17302. 5. Brigden ML, Pattullo A, Brown G. Practising physician’s knowledge and patterns of practice regarding the asplenic state: The need for improved education and a practical checklist. Can J Surg. 2001;44:210-16. 6. Spickett GP, Bullimore J, Wallis J, Smith S, Saunders P. Northern region asplenia register-analysis of first two years. J Clin Pathol. 1999;52:424-9. 7. Kim HS, Kriegel G, Aronson MD. Improving the preventive care of asplenic patients. Am J Med. 2012;125:454-6. 8. Sarangi J, Coleby M, Trivella M, Reilly S. Prevention of post-splenectomy sepsis: A population based approach. J Public Health Med. 1997;19:208–12.
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
2014 vol. 38 no. 6
