| This research project has 2 goals: 1. Determine if current management for post-splenectomy patients in the Netherlands is the same as in international literature, i.e. how many patients have been vaccinated, how many patients receive on-demand antibiotics and revaccination, according to best-practice ? Are patients informed about their situation and the importance of early use of antibiotics? We aim to study splenectomy cases in a representative sample of hospitals, both teaching and non-teaching in the Netherlands to determine the vaccination percentage. Furthermore, we will investigate if patients received on-demand antibiotics at time of discharge, and if patients and GP s received information about the need for (re)vaccination and use of early antibiotics.2. Investigate the reason of failure of current practice: why is best-practice not being followed? Are specialists familiar with the guidelines? Are they aware of the need for vaccination and use of antibiotics? Is it a problem on organizational level? Is it a problem mainly in internal medicine, in surgery, or at GP-level? Is there a problem in communication between specialists? Are GP s well enough informed about the need for (re)vaccination and on-demand antibiotics?Our ultimate goal is to improve the existing situation for splenectomised patients in the Netherlands, with regard to (re)vaccination and early use of antibiotics. We will prepare a national guideline for specialists as well as GP s, in which our identified implementation problems will be addressed. The guideline should cover: 1. recommendations for (re)vaccination (with Pneumovax, Hib and meningococ C), 2. recommendations regarding the use of antibiotics in case of infection as well as on-demand antibiotics, 3. recommendations in informing patients about the hazards of their situation, 4. recommendations about labeling patients records and GP s databases in the Netherlands, with regard to risks and vaccination-status. SummarySplenectomised patients have a high risk of developing serious infections with encapsulated bacteria, such as Streptococcus pneumoniae. This can result in post-splenectomy sepsis (PSS) or overwhelming post-splenectomy infection (OPSI), which has a mortality of 50%. Because of this high mortality rate, guidelines were developed to improve the management of asplenic patients. In these guidelines, several recommendations are being offered concerning immunization, early antibiotic therapy and patient-advice. From both practice and literature however, it becomes clear that these standards are currently not met. Approximately 70% of patients described in recent literature is vaccinated with Pneumovax, and even less with all 3 recommended vaccines (Pneumovax combined with Haemophilus influenzae type B and meningococcus group C vaccines). This rate should be 100%. There is little information in literature about early use of antibiotics and patient information.This study has two goals:1. Determine whether the splenectomised patients in the Netherlands are managed according to state-of-the-art knowledge, as described in international guidelines.2. Determine the impeding factors in compliance with the international post-splenectomy guidelines and management of post-splenectomy patients according to best-practice .Study designAd 1. An a-select representative sample will be investigated in 30 Dutch hospitals to determine the vaccination rate in splenectomised patients. We will also investigate if patients receive on-demand antibiotics at time of discharge and if patients and GP s receive information about early use of antibiotics and revaccination.Ad 2. A short questionnaire will be sent to physicians to investigate their barriers of adherence to best-practice , after identifying potential barriers in focus groups. Time schedule: This project is scheduled to take 30 months.Our goal is to show that management for post-splenectomy patients in the Netherlands is not different from international literature. Our ultimate goal is to work up to a national guideline to improve the management of post-splenectomy patients in the Netherlands and reduce mortality in this group. |
