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Mukinayi Mbiya B, Tumba Disashi G, Gulbis B. Sickle Cell Disease in the Democratic Republic of Congo: Assessing Physicians' Knowledge and Practices. Trop Med Infect Dis 2020; 5:tropicalmed5030127. [PMID: 32751148 PMCID: PMC7559132 DOI: 10.3390/tropicalmed5030127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Sickle cell disease is a major public health issue in the Democratic Republic of Congo (DRC), but it is still poorly understood by health professionals. The objective of this study was to assess the knowledge and practices of Congolese physicians treating sickle cell disease (SCD), in order to identify the areas for improvement in clinical care. Methods: This was a descriptive observational study conducted among Congolese physicians using a questionnaire. Participants were evaluated using a pre-established answer grid. Results: A total of 460 physicians participated, including 81 women (18%), with an average age of 35 years (range 25–60 years). Most physicians were general practitioners. Although self-assessment of their level of knowledge on SCD was estimated as average to good, less than half of the participants (n = 460; 46%) reported adequate management of vaso-occlusive crises, and only 1% of them had received specific training on SCD. Most physicians reported difficulties both in terms of diagnostic (65%) and management (79%) options of SCD patients. This study also showed that 85% of these physicians did not have access to the diagnostic tools for SCD. Conclusions: Insufficient knowledge on SCD and poor diagnostic and treatment options might contribute to increased morbidity and mortality of patients living in the DRC. Interventions aiming to improve physicians’ knowledge, patient follow-up, and treatment access are needed. Specific training alongside existing programs (HIV, malaria), early diagnosis of the disease, and the creation of patient advocacy groups should be implemented to improve SCD patient care.
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Affiliation(s)
- Benoît Mukinayi Mbiya
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, Mbujimayi 06201, Democratic Republic of Congo;
| | - Ghislain Tumba Disashi
- Internal Medicine Department, Faculty of Medicine, University of Mbujimayi, Mbujimayi 06201, Democratic Republic of Congo;
| | - Béatrice Gulbis
- Clinical Chemistry Department-Hereditary Red Blood Cell Disorders, Laboratoire Hospitalier Universitaire de Bruxelles-Universitaire Laboratorium Brussel, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Correspondence:
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2
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Creary SE, Modi AC, Stanek JR, Chisolm DJ, O'Brien SH, Nwankwo C, Crosby LE. Allocation of Treatment Responsibility and Adherence to Hydroxyurea Among Adolescents With Sickle Cell Disease. J Pediatr Psychol 2020; 44:1196-1204. [PMID: 31403687 DOI: 10.1093/jpepsy/jsz061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Adolescents with sickle cell disease (SCD) are at increased risk for complications. Hydroxyurea is a medication that can ameliorate risk but to benefit, adolescents must adhere to treatment. Study aims were to describe how adolescents and their caregivers decided who was responsible for treatment tasks, to describe adolescents' and caregivers' responsibility for these tasks, and to examine if hydroxyurea adherence was associated with younger adolescent age, less discrepancy between adolescents' and caregivers' reports of adolescent responsibility, and higher caregiver involvement. METHODS Twenty-nine dyads completed treatment responsibility measures. A combination of laboratory and electronic prescription data were used to determine hydroxyurea adherence and electronic medical records were used to determine appointment adherence. RESULTS Few dyads agreed or planned how to complete treatment tasks. Adolescents shared responsibility with caregivers for medication-taking tasks. Adolescents perceived caregivers and caregivers perceived adolescents were overall responsible for treatment, especially for appointment tasks. Half of adolescents were adherent to hydroxyurea and half were adherent to appointments but medication adherence was not associated with age, discrepancy between adolescents' and caregivers' responses, or caregiver involvement. CONCLUSIONS Despite frequent hydroxyurea and appointment nonadherence, few adolescents and caregivers plan how to manage adolescents' SCD treatment or perceive they are overall responsible. Future studies are needed to determine the factors that influence these perceptions and if increasing adolescent and caregiver treatment planning improves adherence and clinical outcomes.
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Affiliation(s)
- Susan E Creary
- Center for Innovation in Pediatric Practice, Nationwide Children's Hospital Research Institute, The Ohio State University.,Division of Hematology/Oncology/BMT Nationwide Children's Hospital
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,College of Medicine, University of Cincinnati
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT Nationwide Children's Hospital
| | - Deena J Chisolm
- Center for Innovation in Pediatric Practice, Nationwide Children's Hospital Research Institute, The Ohio State University
| | - Sarah H O'Brien
- Center for Innovation in Pediatric Practice, Nationwide Children's Hospital Research Institute, The Ohio State University.,Division of Hematology/Oncology/BMT Nationwide Children's Hospital
| | - Cara Nwankwo
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Lori E Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,College of Medicine, University of Cincinnati
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3
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Shaw R, Kappa S, Nickel RS. Inpatient Ordering of Home Hydroxyurea by Residents for Hospitalized Patients With Sickle Cell Disease. J Pediatr Hematol Oncol 2020; 42:e38-e41. [PMID: 31688620 DOI: 10.1097/mph.0000000000001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hydroxyurea is a well-established disease-modifying medication for sickle cell disease (SCD). At some institutions, hydroxyurea can only be ordered by "chemotherapy-certified" providers which may not include pediatric resident physicians. METHODS We conducted a survey of 39 American pediatric hospitals regarding their policy on resident hydroxyurea ordering for SCD. Our institution changed its policy in June 2016 to allow residents to order hydroxyurea for hospitalized patients with SCD who were already on hydroxyurea at home. We conducted a retrospective review of the medical records of a random sample of patients with SCD on hydroxyurea admitted the year before and the year after this policy change. RESULTS In our national survey, 51% of surveyed hospitals allowed residents to order hydroxyurea, 19% required a second signature, and 30% did not allow residents to order hydroxyurea. In our institutional study, patients after the policy change were significantly more likely to have received their home hydroxyurea by hospital day 1: before 62/90 (69%) versus after 105/119 (88%), P=0.0005. The proportion of patients who inappropriately received hydroxyurea was very low in both groups: before 1/91 (1%) versus after 3/126 (2%), P=0.64, with no serious adverse clinical events due to inappropriate hydroxyurea administration. CONCLUSIONS Considerable national variation in practice currently exists in regards to resident hydroxyurea ordering hospital policies. A policy allowing residents to order hydroxyurea significantly increased the likelihood of a patient receiving hydroxyurea while hospitalized with no significant increase in inappropriate hydroxyurea administration. Resident hydroxyurea ordering seems safe and beneficial.
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Affiliation(s)
- Rebekah Shaw
- C. S. Mott Children's Hospital at the University of Michigan, Ann Arbor, MI
| | | | - Robert S Nickel
- Children's National Health System.,The George Washington University School of Medicine and Health Sciences, Washington, DC
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Reeves SL, Jary HK, Gondhi JP, Raphael JL, Lisabeth LD, Dombkowski KJ. Hydroxyurea Initiation Among Children With Sickle Cell Anemia. Clin Pediatr (Phila) 2019; 58:1394-1400. [PMID: 31113236 PMCID: PMC7060659 DOI: 10.1177/0009922819850476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assesses characteristics of children with sickle cell anemia associated with hydroxyurea initiation. Medicaid administrative claims from 6 states (2005-2012) were used to identify children with sickle cell anemia enrolled in Medicaid for ≥2 years. Hydroxyurea use was defined as >30 days' supply of filled prescriptions. Children were classified as initiators (no use in year 1; use in year 2) or nonusers (no use in either year). Logistic regression was used to estimate associations between initiation, health care encounters, and demographics. A total of 4435 children were enrolled for 2 years during the study period; 885 (20.0%) initiators and 3080 (69.4%) nonusers. Children had an annual mean of 2.0 sickle cell disease-related inpatient admissions (SD = 2.2), 8.2 sickle cell disease-related outpatient visits (SD = 7.2), and 3.6 emergency department visits (SD = 3.5). The odds of initiating hydroxyurea increased with increasing health care utilization, age, and calendar year (all P values <.05).
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Affiliation(s)
- Sarah L. Reeves
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | - Hannah K. Jary
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | - Jennifer P. Gondhi
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | - Jean L. Raphael
- Clinical Care Center, Texas Children’s Hospital, Houston, TX
| | | | - Kevin J. Dombkowski
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
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5
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Pecker LH, Kappa S, Greenfest A, Darbari DS, Nickel RS. Targeted Hydroxyurea Education after an Emergency Department Visit Increases Hydroxyurea Use in Children with Sickle Cell Anemia. J Pediatr 2018; 201:221-228.e16. [PMID: 30251637 PMCID: PMC6159227 DOI: 10.1016/j.jpeds.2018.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/17/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the impact of an initiative to increase hydroxyurea use among children with sickle cell anemia (SCA) who presented to the emergency department (ED). STUDY DESIGN This observational cohort study included children with SCA not taking hydroxyurea who presented to the ED with pain or acute chest syndrome and then attended a Quick-Start Hydroxyurea Initiation Project (Q-SHIP) session. A Q-SHIP session includes a hematologist-led discussion on hydroxyurea, a video of patients talking about hydroxyurea, and a direct offer to start hydroxyurea. RESULTS Over 64 weeks, 112 eligible patients presented to the ED and 59% (n = 66) participated in a Q-SHIP session a median of 6 days (IQR 2, 20 days) after ED or hospital discharge; 55% of participants (n = 36) started hydroxyurea. After a median follow-up of 49 weeks, 83% (n = 30) of these participants continued hydroxyurea. Laboratory markers of hydroxyurea adherence were significantly increased from baseline: median mean corpuscular volume +8.6 fL (IQR 5.0, 17.7, P < .0001) and median hemoglobin F +5.7% (IQR 2.5, 9.8, P = .0001). Comparing Q-SHIP participants to nonparticipants, 12 weeks after ED visit, participants were more likely to have started hydroxyurea than nonparticipants (53% vs 20%, P = .0004) and to be taking hydroxyurea at last follow-up (50% vs 20%, P = .001). Two years after the implementation of Q-SHIP the overall proportion of eligible patients on hydroxyurea presenting to our ED increased from 56% to 80%, P = .0069. CONCLUSIONS Participation in a clinic to specifically address starting hydroxyurea after a SCA complication increases hydroxyurea use.
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Affiliation(s)
- Lydia H. Pecker
- Division of Hematology, Department of Pediatrics, Johns Hopkins University, Baltimore MD
| | - Sarah Kappa
- Division of Hematology, Children’s National Health System, Washington D.C
| | - Adam Greenfest
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Deepika S. Darbari
- Division of Hematology, Children’s National Health System, Washington D.C,George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Robert Sheppard Nickel
- Division of Hematology, Children's National Health System, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
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Hulbert ML, Shenoy S. Hematopoietic stem cell transplantation for sickle cell disease: Progress and challenges. Pediatr Blood Cancer 2018; 65:e27263. [PMID: 29797658 DOI: 10.1002/pbc.27263] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
Sickle cell disease (SCD) presents challenges to hematopoietic stem cell transplantation (HSCT), including donor availability and morbidity with age/disease severity. However, severe SCD causes irreversible organ damage that HSCT can mitigate. This benefit must be balanced against preparative regimen toxicity, graft-versus-host disease, and mortality risk. We review efforts to balance HSCT complications with the promise of cure, and knowledge gaps that warrant further investigation. We highlight the burden of SCD, HSCT risks and benefits, and SCD families' approach to this balance. We emphasize the necessity for information exchange to ensure a joint decision-making process between providers and patients.
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Affiliation(s)
- Monica L Hulbert
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Shalini Shenoy
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis, St. Louis, Missouri
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Willen SM, Rodeghier M, Rosen CL, DeBaun MR. Sleep disordered breathing does not predict acute severe pain episodes in children with sickle cell anemia. Am J Hematol 2018; 93:478-485. [PMID: 29266432 DOI: 10.1002/ajh.25013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/09/2022]
Abstract
Conflicting evidence has suggested that low mean nocturnal hemoglobin oxygen saturation (SpO2 ) predicts future hospital days for acute severe pain in children with sickle cell anemia (SCA). In an unselected multicenter prospective cohort study, we tested the hypothesis that either low mean nocturnal SpO2 or high obstructive apnea-hypopnea index (OAHI; the number of obstructive apneas and hypopneas with ≥ 3% desaturation or arousal per hour of sleep) or high oxygen desaturation index (ODI; number of ≥ 3% desaturation from baseline saturation per hour of sleep) is associated with increased incidence rates of pain. A total of 140 children with SCA with a median age of 10.8 years (interquartile range 7.2) were followed for a median of 4.9 years (interquartile range 1.8). Overnight polysomnography evaluations at baseline health exam were measured and adjudicated centrally. Multivariable models created in two steps were included. First, all plausible covariates were included in a screening model. Subsequently, covariates meeting level of statistical significance of P < .20 were included in the final model. Contrary to our hypothesis, higher (but not lower) mean nocturnal SpO2 was associated with higher rates of pain episodes (Incidence rate ratio (IRR) 1.10, 95% CI [1.03-1.18], P = .004). Higher log OAHI did not pass screening criteria. Higher log ODI was not significantly associated with higher rates of pain episodes (IRR 0.93, 95% CI [0.82-1.06], P = .28). Neither low nocturnal SpO2, higher OAHI, nor higher ODI were associated with clinically relevant increased incidence rates of acute severe pain episodes.
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Affiliation(s)
- Shaina M. Willen
- Department of Pediatrics, Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | | | - Carol L. Rosen
- Department of Pediatrics, Division of Pediatric Pulmonary, Allergy/Immunology and Sleep; University Hospitals-Cleveland Medical Center, Rainbow Babies and Children's Hospitals; Cleveland Ohio
| | - Michael R. DeBaun
- Department of Pediatrics, Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
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8
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Nahata L, Caltabellotta NM, Ball K, O'Brien SH, Creary SE. Desire for parenthood and reproductive health knowledge in adolescents and young adults with sickle cell disease and their caregivers. Pediatr Blood Cancer 2018; 65. [PMID: 28944997 DOI: 10.1002/pbc.26829] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVE Sickle cell disease (SCD) and hydroxyurea have implications for fertility and reproductive health. The goal of this study was to examine desire for parenthood and reproductive health knowledge among a cohort of adolescent and young adult (AYA) with SCD receiving hydroxyurea and their caregivers at a large pediatric academic center. METHODS Patients with SCD were approached from September 2016 to July 2017 if they were: (1) 12-20 years old, (2) prescribed hydroxyurea for at least 6 months, (3) proficient in English, and (4) accompanied by a caregiver who was proficient in English and willing to participate. Participants self-reported sociodemographic characteristics and completed surveys to assess their/their child's desire for parenthood and other life goals, and reproductive health knowledge. RESULTS Eighteen patient-caregiver dyads completed the study (78.3% of those eligible); 61.1% indicated that they wanted to have future biological children. Few participants reported receiving information about fertility (16.7% of AYA and 27.8% of caregivers) or birth control (11.1% of AYA and 22.2% of caregivers) from their/their child's health care provider, and the majority had received no information on these topics. Less than half of participants reported that SCD (22.2% of AYA and 50.0% of caregivers) or hydroxyurea (11.1% of AYA and 27.8% of parents) could potentially impair fertility. CONCLUSIONS Biological parenthood was important to this cohort yet fertility and reproductive health knowledge was low, suggesting that clinicians should prioritize conversations about infertility risk and birth control options with AYA with SCD on hydroxyurea and their caregivers. More research is needed to identify optimal approaches to these discussions.
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Affiliation(s)
- Leena Nahata
- Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicole M Caltabellotta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Kyle Ball
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Sarah H O'Brien
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Hematology and Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Susan E Creary
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Hematology and Oncology, Nationwide Children's Hospital, Columbus, Ohio
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Bundy DG, Richardson TE, Hall M, Raphael JL, Brousseau DC, Arnold SD, Kalpatthi RV, Ellison AM, Oyeku SO, Shah SS. Association of Guideline-Adherent Antibiotic Treatment With Readmission of Children With Sickle Cell Disease Hospitalized With Acute Chest Syndrome. JAMA Pediatr 2017; 171:1090-1099. [PMID: 28892533 PMCID: PMC5710371 DOI: 10.1001/jamapediatrics.2017.2526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE Acute chest syndrome (ACS) is a common, serious complication of sickle cell disease (SCD) and a leading cause of hospitalization and death in both children and adults with SCD. Little is known about the effectiveness of guideline-recommended antibiotic regimens for the care of children hospitalized with ACS. OBJECTIVES To use a large, national database to describe patterns of antibiotic use for children with SCD hospitalized for ACS and to determine whether receipt of guideline-adherent antibiotics was associated with lower readmission rates. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study including 14 480 hospitalizations in 7178 children (age 0-22 years) with a discharge diagnosis of SCD and either ACS or pneumonia. Information was obtained from 41 children's hospitals submitting data to the Pediatric Health Information System from January 1, 2010, to December 31, 2016. EXPOSURES National Heart, Lung, and Blood Institute guideline-adherent (macrolide with parenteral cephalosporin) vs non-guideline-adherent antibiotic regimens. MAIN OUTCOMES AND MEASURES Acute chest syndrome-related and all-cause 7- and 30-day readmissions. RESULTS Of the 14 480 hospitalizations, 6562 (45.3%) were in girls; median (interquartile range) age was 9 (4-14) years. Guideline-adherent antibiotics were provided in 10 654 of 14 480 hospitalizations for ACS (73.6%). Hospitalizations were most likely to include guideline-adherent antibiotics for children aged 5 to 9 years (3230 of 4047 [79.8%]) and declined to the lowest level for children 19 to 22 years (697 of 1088 [64.1%]). Between-hospital variation in antibiotic regimens was wide, with use of guideline-adherent antibiotics ranging from 24% to 90%. Children treated with guideline-adherent antibiotics had lower 30-day ACS-related (odds ratio [OR], 0.71; 95% CI, 0.50-1.00) and all-cause (OR, 0.50; 95% CI, 0.39-0.64) readmission rates vs children who received other regimens (cephalosporin and macrolide vs neither drug class). CONCLUSIONS AND RELEVANCE Current approaches to antibiotic treatment in children with ACS vary widely, but guideline-adherent therapy appears to result in fewer readmissions compared with non-guideline-adherent therapy. Efforts to increase the dissemination and implementation of SCD treatment guidelines are warranted as is comparative effectiveness research to strengthen the underlying evidence base.
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Affiliation(s)
- David G Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston
| | - Troy E Richardson
- Department of Research and Statistics, Children's Hospital Association, Lenexa, Kansas
| | - Matthew Hall
- Department of Research and Statistics, Children's Hospital Association, Lenexa, Kansas
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Staci D Arnold
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Ram V Kalpatthi
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine
| | - Angela M Ellison
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Suzette O Oyeku
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Section editor
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10
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Creary SE, O'Brien SH, Stanek J, Hankins JS, Garee A, Ball KR, Andrews TM, Chisolm DJ. A Retrospective Review to Determine If Children with Sickle Cell Disease Receive Hydroxyurea Monitoring. Pediatr Qual Saf 2017; 2. [PMID: 29399659 PMCID: PMC5793862 DOI: 10.1097/pq9.0000000000000024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Sickle cell disease guidelines recommend that patients on hydroxyurea receive monitoring at least every 2–3 months, but it is unknown if this occurs in clinical practice. This study aimed to determine if patients with sickle cell disease at Nationwide Children’s Hospital had at least 4, in-person monitoring visits during a 12-month period and if frequent monitoring was associated with hydroxyurea adherence and clinical outcomes. Methods: We performed a retrospective analysis of children on hydroxyurea for at least 12 months during 2010–2015. Patients’ demographics, laboratory studies, prescriptions, and number of hydroxyurea and acute visits were recorded from their 12-month period that met eligibility criteria. Patients were considered frequently monitored if they had ≥ 4 hydroxyurea visits and adherent if they had prescriptions for hydroxyurea for ≥ 80% of the days in their 12-month period. Results: Seventy-four children met the eligibility criteria and 57 (77%) had frequent monitoring. The most common reason for not obtaining frequent monitoring was missing a scheduled appointment. A greater proportion of frequently monitored patients were adherent to hydroxyurea (66.7% versus 17.7%; P < 0.001), and they had significantly fewer acute visits (median 1 versus 2 visits; P = 0.032) compared with infrequently monitored patients. Conclusions: Our study shows that most children on hydroxyurea at Nationwide Children’s Hospital received frequent monitoring and that it was associated with improved adherence and outcomes. Our results suggest that frequent in-person monitoring could be an opportunity to identify poorly adherent patients. These data inform our next quality improvement initiative that will maximize adherence to these monitoring guidelines.
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Affiliation(s)
- Susan E Creary
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Sarah H O'Brien
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Joseph Stanek
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | - Amy Garee
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Kyle R Ball
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Tina M Andrews
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Deena J Chisolm
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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