We reviewed an additional 47 studies addressing barriers to the treatment of patients with sickle cell disease and interventions to overcome these barriers. In our review of barriers to adequate pain management, we found two factors that were identified as a barrier in more than two studies: negative provider attitudes and poor provider knowledge. Because of the quantity and consistency of these findings, we concluded that the evidence was high-grade that negative provider attitudes are barriers and moderate-grade that poor provider knowledge is a barrier to the use of pain medications in patients with sickle cell disease. The evidence.
