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Aristizabal P, Nataraj S, Ma AK, Kumar NV, Perdomo BP, Martinez ME, Nodora J, Liu L, Lee E, Thornburg CD. Social Determinants of Health and Informed Consent Comprehension for Pediatric Cancer Clinical Trials. JAMA Netw Open 2023; 6:e2346858. [PMID: 38079173 PMCID: PMC10714248 DOI: 10.1001/jamanetworkopen.2023.46858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Ensuring valid informed consent (IC) prior to enrollment in clinical trials is a fundamental ethical right. Objective To assess whether social determinants of health (SDOH) and related sociocontextual factors are associated with parental IC comprehension in therapeutic childhood cancer clinical trials. Design, Setting, and Participants This cross-sectional study prospectively enrolled 223 parents of children with newly diagnosed cancer at Rady Children's Hospital San Diego, a large quaternary academic center in California, from October 1, 2014, to March 31, 2021. Linear mixed effects models were used to assess whether IC comprehension overall and by domain (purpose, procedures, and randomization; risks and benefits; alternatives; and voluntariness) were associated with SDOH and sociocontextual factors. Data were analyzed from January 1, 2022, to July 31, 2023. Exposures Informed consent for a therapeutic childhood cancer clinical trial. Main Outcomes and Measures The primary outcome of interest was IC comprehension and its associations with SDOH (marital status, language, educational attainment, employment, insurance type, socioeconomic status, and health literacy) and sociocontextual factors (ethnicity, satisfaction with informed consent, and cancer type). Results Of 223 parents, 172 (77.1%) were aged 18 to 44 years, 111 (49.8%) were Hispanic, 152 (68.2%) were women, and 163 (73.1%) were married. In terms of race, 2 (0.9%) were American Indian or Alaska Native, 22 (9.9%) were Asian or Pacific Islander, 8 (3.6%) were Black, 149 (66.8%) were White, and 42 (18.8%) were more than 1 race. In multivariable linear mixed-effects analyses, limited vs adequate health literacy was associated with lower comprehension of informed consent overall (mean [SD], 68.28 [11.81] vs 79.24 [11.77]; β estimate, -9.02 [95% CI, -12.0 to -6.07]; P < .001) and with lower comprehension of the purpose, procedures, and randomization (mean [SD], 65.00 [12.64] vs 76.14 [11.53]; β estimate, -7.87 [95% CI, -10.9 to -4.85]; P < .001); risks and benefits (mean [SD], 62.84 [20.24] vs 73.14 [20.86]; β estimate, -10.1 [95% CI, -15.6 to -4.59]; P < .001); alternatives (mean [SD], 54.27 [43.18] vs 82.98 [34.24]; β estimate, -14.3 [95% CI, -26.1 to -2.62]; P .02); and voluntariness (mean [SD], 76.52 [24.33] vs 95.39 [13.89]; β estimate, -9.14 [95% CI, -14.9 to -3.44]; P = .002) domains. Use of Spanish vs English language for medical communication was associated with lower comprehension overall (mean [SD], 66.45 [12.32] vs 77.25 [12.18]; β estimate, -5.30 [95% CI, -9.27 to -1.34]; P = .01) and with lower comprehension of the purpose, procedures, and randomization (mean [SD], 63.33 [11.98] vs 74.07 [12.52]; β estimate, -4.33 [95% CI, -8.43 to -0.23]; P = .04) and voluntariness (mean [SD], 70.83 [24.02] vs 92.54 [17.27]; β estimate, -9.69 [95% CI, -16.8 to -2.56]; P = .009) domains. Conclusions and Relevance In this cross-sectional study including parents of children with newly diagnosed cancer who provided IC for their child's participation in a therapeutic clinical trial, limited health literacy and use of Spanish language for medical communication were associated with lower comprehension of IC. These findings suggest that, in this setting, parents with limited health literacy or those who use Spanish language for medical communication may not fully comprehend IC and therefore may not make truly informed decisions. These findings support the investigation of interventions, across pediatric disciplines, tailored to the participant's language and health literacy level to improve IC comprehension, particularly in racial and ethnic minority populations.
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Affiliation(s)
- Paula Aristizabal
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
- Peckham Center for Cancer & Blood Disorders, Rady Children’s Hospital San Diego, San Diego, California
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Dissemination and Implementation Science Center, University of California, San Diego, Altman Clinical and Translational Research Institute, La Jolla
| | - Shilpa Nataraj
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Pediatrics, Division of Hematology Oncology, Stanford University, Stanford, California
| | - Arissa K. Ma
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Family Medicine, Kaiser Permanente, Long Beach, California
| | - Nikhil V. Kumar
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Pediatrics, University of California Irvine, Irvine, California
| | - Bianca P. Perdomo
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
| | - Maria Elena Martinez
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
| | - Jesse Nodora
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
| | - Lin Liu
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
- Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla
| | - Courtney D. Thornburg
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
- Peckham Center for Cancer & Blood Disorders, Rady Children’s Hospital San Diego, San Diego, California
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2
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Rickey L, Auger K, Britto MT, Rodgers I, Field S, Odom A, Lehr M, Cronin A, Walsh KE. Measurement of Ambulatory Medication Errors in Children: A Scoping Review. Pediatrics 2023; 152:e2023061281. [PMID: 37986581 DOI: 10.1542/peds.2023-061281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children use most medications in the ambulatory setting where errors are infrequently intercepted. There is currently no established measure set for ambulatory pediatric medication errors. We have sought to identify the range of existing measures of ambulatory pediatric medication errors, describe the data sources for error measurement, and describe their reliability. METHODS We performed a scoping review of the literature published since 1986 using PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane and of grey literature. Studies were included if they measured ambulatory, including home, medication errors in children 0 to 26 years. Measures were grouped by phase of the medication use pathway and thematically by measure type. RESULTS We included 138 published studies and 4 studies from the grey literature and identified 21 measures of medication errors along the medication use pathway. Most measures addressed errors in medication prescribing (n = 6), and administration at home (n = 4), often using prescription-level data and observation, respectively. Measures assessing errors at multiple phases of the medication use pathway (n = 3) frequently used error reporting databases and prospective measurement through direct in-home observation. We identified few measures of dispensing and monitoring errors. Only 31 studies used measurement methods that included an assessment of reliability. CONCLUSIONS Although most available, reliable measures are too resource and time-intensive to assess errors at the health system or population level, we were able to identify some measures that may be adopted for continuous measurement and quality improvement.
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Affiliation(s)
- Lisa Rickey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Katherine Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabelle Rodgers
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Shayna Field
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alayna Odom
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Madison Lehr
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Phillips S, Schlenz AM, D'Alton S, Johnson M, Kanter J. Patient and Family Opioid Decision-Making for Pain Management in Sickle Cell Disease: A Qualitative Study. THE JOURNAL OF PAIN 2023; 24:1240-1250. [PMID: 36863679 PMCID: PMC10329994 DOI: 10.1016/j.jpain.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
Pain is a significant symptom experienced frequently by individuals with sickle cell disease (SCD). Pain management includes strategies such as oral rehydration, non-pharmacological therapies (eg, massage, relaxation), and oral analgesics and opioids. Shared decision-making around pain management is emphasized repeatedly in recent guidelines; however, research is sparse regarding factors to be considered in shared decision-making approaches including the perceived risks and benefits of opioids. This qualitative descriptive study was conducted to explore perspectives of decision-making for opioid medications in SCD. We conducted 20 in-depth interviews with caregivers of children with SCD and individuals with SCD to elucidate the decision-making processes around home use of opioid therapy for pain management at a single center. Themes were identified in the domains of the Decision Problem (Alternatives and Choices; Outcomes and Consequences; Complexity), the Context (Multilevel Stressors and Supports; Information; Patient-Provider Interactions), and the Patient (Decision-Making Approaches; Developmental Status; Personal and Life Values; Psychological State). Key findings indicated opioid management for pain in SCD is important yet complex and requires collaboration among patients, families, and providers. Elements of patient and caregiver decision-making identified in this study may be applied to shared decision-making strategies in the clinical setting and future study. PERSPECTIVE: This study illustrates the factors involved in decision-making around home opioid use for pain management in children and young adults with SCD. These findings can be applied to determining shared decision-making approaches around pain management between providers and patients, in accordance with recent SCD pain management guidelines.
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Affiliation(s)
- Shannon Phillips
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
| | - Alyssa M Schlenz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Shannon D'Alton
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Mary Johnson
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Julie Kanter
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Khan H, Krull M, Hankins JS, Wang WC, Porter JS. Sickle cell disease and social determinants of health: A scoping review. Pediatr Blood Cancer 2023; 70:e30089. [PMID: 36495544 PMCID: PMC9790038 DOI: 10.1002/pbc.30089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
Social determinants of health (SDoH) may impact outcomes in sickle cell disease (SCD). We conducted a comprehensive literature review of five electronic databases to elucidate the relationship between SDoH and SCD, and identify gaps in the literature. Our search yielded 59 articles, which we organized into five SDoH areas: Neighborhood and Built Environment, Health and Healthcare, Social and Community Context, Education, and Economic Stability. We found that social determinants, such as access to healthcare, were inconsistently evaluated. Improved recognition and understanding of SDoH should enhance the development of programs that directly address its detrimental effects on patients with SCD.
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Affiliation(s)
- Hamda Khan
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Mathew Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Winfred C. Wang
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Reeves PT, Rogers PL, Hipp SJ, Zanetti RC, Echelmeyer S, Rees DJ, Parekh DS. The Sickle Cell Pain Action Plan: A low health literacy, pictographic tool to enhance self-management, and guideline concordance. Pediatr Blood Cancer 2022; 69:e29775. [PMID: 35593011 DOI: 10.1002/pbc.29775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/26/2022]
Affiliation(s)
- Patrick T Reeves
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Philip L Rogers
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sean J Hipp
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Richard C Zanetti
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sofia Echelmeyer
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Donald J Rees
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Dina S Parekh
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Yin HS, Neuspiel DR, Paul IM, Franklin W, Tieder JS, Adirim T, Alvarez F, Brown JM, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Mueller BU, Connor Phillips S, Quinonez RA, Rea C, Rinke ML, Shaikh U, Shiffman RN, Vickers Saarel E, Spencer Cockerham SP, Mack Walsh K, Jones B, Adler AC, Foster JH, Green TP, Houck CS, Laughon MM, Neville K, Reigart JR, Shenoi R, Sullivan JE, Van Den Anker JN, Verhoef PA. Preventing Home Medication Administration Errors. Pediatrics 2021; 148:183379. [PMID: 34851406 DOI: 10.1542/peds.2021-054666] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.
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Affiliation(s)
- H Shonna Yin
- Departments of Pediatrics and Population Health, Grossman School of Medicine, New York University, New York, New York
| | | | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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7
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Aristizabal P, Ma AK, Kumar NV, Perdomo BP, Thornburg CD, Martinez ME, Nodora J. Assessment of Factors Associated With Parental Perceptions of Voluntary Decisions About Child Participation in Leukemia Clinical Trials. JAMA Netw Open 2021; 4:e219038. [PMID: 33944924 PMCID: PMC8097494 DOI: 10.1001/jamanetworkopen.2021.9038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
IMPORTANCE Obtaining voluntary informed consent prior to enrollment in clinical trials is a fundamental ethical requirement. OBJECTIVE To assess whether health literacy, contextual factors, or sociodemographic characteristics are associated with perception of voluntariness among parents who had consented for their child's participation in a leukemia therapeutic clinical trial. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study prospectively enrolled 97 parents of children diagnosed as having leukemia at Rady Children's Hospital San Diego, a large tertiary academic center in California, from 2014 to 2017. Health literacy, contextual factors (acculturation, decisional regret, and satisfaction with informed consent), sociodemographic characteristics, and perception of voluntariness after consenting for a therapeutic clinical trial were measured. Univariable and multivariable regression were used to determine significant associations. The analyses for the present study were conducted from May 2019 to May 2020. EXPOSURES Informed consent for a therapeutic leukemia clinical trial. MAIN OUTCOMES AND MEASURES The primary outcome of interest was perception of voluntariness and its associations with health literacy and other contextual factors (acculturation, decisional regret, and satisfaction with informed consent) and sociodemographic characteristics, including age, race/ethnicity, parental language, educational level, insurance type, marital status, and socioeconomic status. RESULTS Of 97 parents included, the majority were women (65 [67%]), married (71 [73%]), and of self-reported Hispanic ethnicity (50 [52%]). Lower perception of voluntariness was significantly associated with lower health literacy (r = 0.30; 95% CI, 0.11-0.47; P = .004), Spanish language (x̅ = -4.50, P = .05), lower acculturation if of Hispanic ethnicity (r = 0.30; 95% CI, 0.02-0.54; P = .05), greater decisional regret (r = -0.54; 95% CI, -0.67 to -0.38; P < .001), and lower satisfaction with informed consent (r = 0.39; 95% CI, 0.21-0.54; P < .001) in univariable analysis. Lower health literacy remained significantly associated with lower perception of voluntariness in multivariable analysis after adjustment for contextual factors and sociodemographic characteristics (β = 4.06; 95% CI, 1.60-6.53; P = .001). Lower health literacy was significantly associated with Hispanic ethnicity (mean, 4.16; 95% CI, 3.75-4.57; P < .001), Spanish language spoken at home (mean, 3.17; 95% CI, 1.94-4.40; P < .001), high school or less educational level (mean, 3.41; 95% CI, 2.83-3.99; P < .001), public insurance (mean, 4.00; 95% CI, 3.55-4.45; P < .001), and unmarried status (mean, 3.71; 95% CI, 2.91-4.51; P = .03). CONCLUSIONS AND RELEVANCE Among parents of children with newly diagnosed leukemia who had consented for their child's participation in a therapeutic clinical trial, lower perception of voluntariness was significantly associated with lower health literacy. These results suggest that parents with low health literacy may perceive external influences in their decision for their child's participation in clinical trials. This finding highlights the potential role of recruitment interventions tailored to the participant's health literacy level to improve voluntary informed consent in underserved populations.
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Affiliation(s)
- Paula Aristizabal
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
| | - Arissa K. Ma
- School of Medicine, University of California San Diego, La Jolla
- Now with MemorialCare Health System, Fountain Valley, California
| | - Nikhil V. Kumar
- School of Medicine, University of California San Diego, La Jolla
| | - Bianca P. Perdomo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
| | - Courtney D. Thornburg
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
| | - Maria Elena Martinez
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Jesse Nodora
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
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Muslu CS, Kopetsky M, Nimmer M, Visotcky A, Fraser R, Brousseau DC. The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain. Pediatr Blood Cancer 2020; 67:e28268. [PMID: 32614150 PMCID: PMC7674235 DOI: 10.1002/pbc.28268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The National Heart, Lung, and Blood Institute guidelines for sickle cell disease (SCD) pain crisis management recommend opioids within 60 minutes of emergency department (ED) registration and every 30 minutes thereafter until acute pain is managed. These guidelines are based on expert opinion without published, supporting data. OBJECTIVE To evaluate the association between timely ED opioid administration and hospitalization rates in children with SCD. METHODS Retrospective cohort of children presenting to a children's hospital ED with SCD pain between January 1, 2014, and April 30, 2018. Visits were extracted using ICD codes, chief complaints, and receipt of at least one opioid, and then reviewed to confirm the visit was an uncomplicated pain crisis. The primary outcome was hospitalization, yes or no. Generalized estimating equations were used to determine adjusted odds of hospitalization for the timely administration of initial and second doses of opioids. RESULTS Of the 902 eligible visits, 368 (40.8%) resulted in hospitalization. The mean (SD) age was 11.9 (± 5.2) years. The first opioid was administered within 60 minutes of arrival in 601 (66.6%) visits. The second opioid was administered within 30 minutes of the first in 84 (12.3%) visits. Receipt of the first opioid within 60 minutes of arrival was not associated with decreased hospitalization (1.30 [0.96-1.76]). However, receipt of the second dose within 30 minutes of the first was associated with decreased hospitalization (0.56 [0.33-0.94]). CONCLUSION This study suggests an association between children with SCD receiving a second dose within 30 minutes of the first opioid dose and decreased hospitalizations.
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Affiliation(s)
| | | | - Mark Nimmer
- Medical College of Wisconsin, Milwaukee, WI,Pediatric Emergency Medicine and the Children’s Research Institute of the Children’s Hospital of Wisconsin, Milwaukee, WI
| | - Alexis Visotcky
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Raphael Fraser
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - David C. Brousseau
- Medical College of Wisconsin, Milwaukee, WI,Pediatric Emergency Medicine and the Children’s Research Institute of the Children’s Hospital of Wisconsin, Milwaukee, WI
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9
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Ballas SK, Dampier C. Risk factors associated with increased emergency department utilization in patients with sickle cell disease: a systematic literature review. Ann Hematol 2020; 99:2483-2495. [PMID: 32852615 DOI: 10.1007/s00277-020-04205-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Sickle cell disease (SCD), a genetic disorder affecting up to 100,000 patients in the USA, impacts multiple organ systems. The emergency department (ED) is frequently utilized by patients with SCD who have severe pain from vaso-occlusive crises. The goal of this systematic literature review is to identify predictors for ED use among patients with SCD in the USA, as high ED reliance is not ideal because of the potential for discontinuity of care as well as higher costs. PubMed and Embase were searched for articles containing the keywords "sickle cell disease" AND ("emergency" OR "acute care") AND ("utilization" OR "health care") published between 2000 and 26 September 2019. A total of 26 publications were identified meeting the following inclusion criteria: report of ED or acute care clinic use; report of health care utilization for SCD; and report of ED visits independent of hospital admission, ED revisits, inpatient care visits, and SCD care unit visits. Articles unavailable in English or those focused on populations outside the USA were excluded. Of the 26 articles included, 4 were prospective and the remainder were retrospective. Qualitative analysis of the articles revealed a higher rate of ED utilization among adults than children, patients with public insurance than private insurance, and patients with more comorbidities, complications, or pain. Age and pain levels were both commonly cited as predictors of ED utilization. Additional prospective and interventional studies are needed to further define predictors of ED utilization and to uncover treatments that decrease ED visits.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1020 Locust Street Suite 394, Philadelphia, PA, 19107, USA.
| | - Carlton Dampier
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory Healthcare, Atlanta, GA, USA.,AFLAC Cancer and Blood Disorders Center, Atlanta, GA, USA
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10
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Dahmash DT, Shariff ZB, Kirby DJ, Terry D, Huynh C. Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy. BMJ Paediatr Open 2020; 4:e000841. [PMID: 33305018 PMCID: PMC7692990 DOI: 10.1136/bmjpo-2020-000841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To identify studies that highlighted medication administration problems experienced by parents and children, which also looked at health literacy aspect using a validated tool to assess for literacy. STUDY DESIGN Ten electronic databases were systematically searched and supplemented by hand searching through reference lists using the following search terms: (1) paediatric, (2) medication error including dosing error, medication administration error, medication safety and medication optimisation and (3) health literacy. RESULTS Of the (1230) records screened, 14 studies were eligible for inclusion. Three analytical themes emerged from the synthesis. The review highlighted that frequencies and magnitudes of dosing errors vary by the measurement tools used, the dose prescribed and by the administration instruction provided. Parent's sociodemographic, such as health literacy and language, is a key factor to be considered when designing an intervention aimed at averting medication administration errors at home. The review summarised some potential strategies that could help in reducing medication administration errors among children at home. Among these recommendations is to show the prescribed dose to the parents or young people along with the verbal instructions, as well as to match the prescribed dose with the measuring tool dispensed, to provide an explicit dose intervals and pictographic dosing instructions. CONCLUSION The findings suggest that in order to optimise medication use by parents, further work is needed to address the nature of these issues at home. Counselling, medication administration instructions and measurement tools are some of the areas in addition to the sociodemographic characteristics of parents and young people that need to be considered when designing any future potential intervention aimed at reducing medication errors among children and young people at home.
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Affiliation(s)
- Dania Talaat Dahmash
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Zakia B Shariff
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Daniel J Kirby
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - David Terry
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
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