Acute idiopathic thrombocytopenia purpura (ITP) is a common, generally benign and self-limited auto-immune condition of childhood. An ITP guideline was published by the American Society of Hematology in 2011 which suggested that most acute ITP didn’t require treatment unless active bleeding occurred. Investigators studying quality improvement methods to change clinician behavior in cases such as this have long been aware that the presence of a guideline does not necessarily change clinician behavior and results of clinician educational efforts about guidelines have a fairly disappointing track record….except when they don’t.
Schefft and colleagues, in a study released this month (10.1542/hpeds.2018-0231), used the precaution adoption process model to target specific types of education to providers based on their current stage of thinking about the evidence around treating ITP. For example, for those who were not yet willing to accept the proposition that most ITP treatment was unnecessary (in the absence of significant bleeding) the investigators provided targeted education on the harms of therapy, both in terms of side effects and financial toxicity to families. This targeted education strategy reduced unnecessary treatment of ITP from 70% to <30% over time. This quality improvement report is a model for meaningful engagement with a theory of behavior change and it is nice to see the truism that education doesn’t change behavior challenged.
