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Walden J, Brown L, Seiguer S, Munshaw K, Rausch J, Badawy S, McGann P, Winkler S, Gonzalez L, Creary S. Study protocol for ADHERE (Applying Directly observed therapy to HydroxyurEa to Realize Effectiveness): Using small business partnerships to deliver a scalable and novel hydroxyurea adherence solution to youth with sickle cell disease. PLoS One 2024; 19:e0304644. [PMID: 38917111 PMCID: PMC11198815 DOI: 10.1371/journal.pone.0304644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 06/27/2024] Open
Abstract
Sickle cell disease (SCD) is an inherited blood disorder that affects approximately 100,000 Americans, primarily from underrepresented racial minority populations, and results in costly, multi-organ complications. Hydroxyurea, the primary disease-modifying therapy for SCD, is effective at reducing most complications; however, adherence to hydroxyurea remains suboptimal and is the primary barrier to clinical effectiveness. Video directly observed therapy (VDOT) has shown promise as an adherence-promoting intervention for hydroxyurea, yet previous VDOT trials were limited by high attrition from gaps in technology access, use of unvalidated adherence measures, and healthcare system limitations of delivering VDOT to patients. As such, we fostered a small business partnership to compare VDOT for hydroxyurea to attention control to address previous shortcomings, promote equitable trial participation, and maximize scalability. VDOT will be administered by Scene Health (formerly emocha Health) and adherence monitoring will be performed using a novel electronic adherence monitor developed to meet the unique needs of the target population. Adolescent and young adult patients as well as caregivers of younger patients (<11 years of age) will be recruited. In addition to visit incentives, all participants will be offered a smartphone with a data plan to ensure all participants have equal opportunity to complete study activities. The primary objectives of this pilot, multi-center, randomized controlled trial (RCT) are to assess retention and sustained engagement and to explore needs and preferences for longer-term adherence monitoring and interventions. This RCT is registered with the National Institutes of Health (NCT06264700). Findings will inform a future efficacy RCT applying VDOT to hydroxyurea to address adherence gaps and improve outcomes within this vulnerable population.
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Affiliation(s)
- Joseph Walden
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Lauren Brown
- emocha Mobile Health Inc. Doing Business as Scene and Scene Health, Baltimore, MD, United States of America
| | - Sebastian Seiguer
- emocha Mobile Health Inc. Doing Business as Scene and Scene Health, Baltimore, MD, United States of America
| | - Katie Munshaw
- emocha Mobile Health Inc. Doing Business as Scene and Scene Health, Baltimore, MD, United States of America
| | - Joseph Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Sherif Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children’s Hospital of Chicago, Chicago, IL, United States of America
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Patrick McGann
- Lifespan Comprehensive Sickle Cell Center, Providence, RI, United States of America
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Savannah Winkler
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children’s Hospital of Chicago, Chicago, IL, United States of America
| | - Lisbel Gonzalez
- Lifespan Comprehensive Sickle Cell Center, Providence, RI, United States of America
| | - Susan Creary
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States of America
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Oladipupo F, Stanek J, Walden J, Young J, Rose MJ, Nicol K, Villella A, Creary S. Prevalence of Duffy null and its impact on hydroxyurea in young children with sickle cell disease in the United States. Pediatr Blood Cancer 2024; 71:e30945. [PMID: 38462769 DOI: 10.1002/pbc.30945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
Consistent with studies showing a high prevalence of the Duffy null phenotype among healthy Black Americans, this retrospective study found that Duffy null was present in >75% of a young and contemporary cohort of children with sickle cell disease (SCD) in the United States. Despite the potential for this phenotype to impact absolute neutrophil counts, hydroxyurea (HU) dosing, and outcomes, it was not associated with being prescribed a lower HU dose or having increased acute SCD visits early in the HU treatment course. Future studies are needed to confirm these findings in older children with SCD.
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Affiliation(s)
- Fathia Oladipupo
- Department of Pediatrics, Center for Child Health Equity Outcomes and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph Stanek
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
| | - Joseph Walden
- Department of Pediatrics, Center for Child Health Equity Outcomes and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer Young
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
| | - Melissa J Rose
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
| | - Kathleen Nicol
- Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Anthony Villella
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
| | - Susan Creary
- Department of Pediatrics, Center for Child Health Equity Outcomes and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
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Reeves SL, Dombkowski KJ, Peng HK, Phan H, Kolenic G, Creary SE, Madden B, Lisabeth L. Reply to: Comment on: "Adherence to hydroxyurea and clinical outcomes among children with sickle cell anemia". Pediatr Blood Cancer 2023; 70:e30630. [PMID: 37592368 DOI: 10.1002/pbc.30630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Sarah L Reeves
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin J Dombkowski
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Hannah K Peng
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Hanna Phan
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Giselle Kolenic
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan E Creary
- School of Medicine, Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, The Ohio State University, Columbus, Ohio, USA
| | - Brian Madden
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynda Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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McCrossan P, O'Donoghue D, McElnay JC, Shields MD. The use of remote video directly observed therapy to improve both inhaler technique and adherence to asthma medications. Front Public Health 2022; 10:965629. [PMID: 36276358 PMCID: PMC9581185 DOI: 10.3389/fpubh.2022.965629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023] Open
Abstract
Incorrect inhaler technique and non-adherence to inhaled preventer therapy often is the cause of poorly controlled asthma. Detecting and correcting non-adherence in asthma therapy has proven difficult. In addition, while patients may be able to demonstrate correct inhaler technique at the clinic recent evidence suggests that critical errors in inhaler technique occur in the home setting. Remote video directly observed therapy (vDOT) has recently been described as a potentially useful tool for addressing non-adherence while also allowing timely correction of inhaler technique errors. In this mini-review we describe the use of vDOT in asthma management.
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Affiliation(s)
- Paddy McCrossan
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom,Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Dara O'Donoghue
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom,Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | | | - Michael D. Shields
- Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom,Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom,*Correspondence: Michael D. Shields
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Health-Related Quality of Life and Adherence to Hydroxyurea and Other Disease-Modifying Therapies among Individuals with Sickle Cell Disease: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2122056. [PMID: 35898672 PMCID: PMC9313963 DOI: 10.1155/2022/2122056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
Background Sickle cell disease (SCD) is a hemoglobinopathy with increasing global prevalence resulting in pain episodes and multiorgan complications. Complications of SCD have been shown to adversely impact health-related quality of life (HRQOL) comprised of physical, social, and emotional domains; hence, HRQOL measures can serve as an effective evaluator of disease burden. Hydroxyurea (HU) and other disease-modifying therapies have demonstrated to significantly improve clinical outcomes in patients with SCD. Medication adherence is an essential mediator of the clinical benefits of these therapies; low adherence has been shown to increase disease burden and healthcare utilization. This systematic literature review intends to determine the association between adherence to disease-modifying therapies and HRQOL in patients with SCD. Methods We found a total of 12 articles involving 788 participants, which included both patients with SCD and caregivers/parents. Adherence was measured using self-report instruments, laboratory markers, such as fetal hemoglobin and mean corpuscular volume, and mHealth medication trackers. HRQOL was measured using self-report instruments. Results All studies demonstrated a correlation between higher HU adherence and better HRQOL scores. Higher HU adherence was associated with lower pain impact, less frequent pain episodes, less fatigue, and improved physical function and mobility, reflecting better physical HRQOL outcomes. Higher adherence was also associated with improved emotional response, decreased anxiety and depressive symptoms, and better social functioning and peer relationships. In addition, our findings indicated that having less frequent barriers to HU adherence was associated with better HRQOL scores. No studies evaluated HRQOL outcomes in relation to adherence to l-glutamine, voxelotor, or crizanlizumab. Conclusions Optimizing HU adherence has the potential to improve HRQOL in patients with SCD in addition to reducing healthcare utilization and improving treatment satisfaction. Addressing barriers to HU adherence can positively strengthen the relationship between adherence and HRQOL to potentially improve patient outcomes.
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Shaner S, Hilliard L, Howard T, Pernell B, Bhatia S, Lebensburger J. Impact of telehealth visits on hydroxyurea response in sickle cell anemia. Pediatr Blood Cancer 2021; 68:e29354. [PMID: 34532949 DOI: 10.1002/pbc.29354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is important to ensure access to hydroxyurea (HU) for patients with sickle cell anemia (SCA) living in rural areas. The University of Alabama at Birmingham (UAB) Pediatric Sickle Cell program's satellite clinics reduce the barrier of transportation to the university-based clinic. However, as compared with the university clinic, these satellite clinics do not offer immediate access to HU dosing laboratory results and a nurse clinician calls families with HU dose adjustments after the clinic visit. This study evaluated the impact of telehealth dosing adjustments on HU laboratory and clinical response as compared with university-based patients. METHODS A one-year retrospective chart review was performed to evaluate HU laboratory and clinical response based on clinic location and socioeconomic status for patients with SCA. We identified the number of clinic and acute care visits for one year and calculated the mean complete blood count and fetal hemoglobin (HbF) values for each patient. RESULTS We identified 107 academic center participants with SCA-prescribed HU and 65 satellite clinic participants. The mean age of participants was 11 ± 5 years. We identified no difference in HbF (13.3 ± 0.7 vs 11.7 ± 0.8, P = 0.13), Hb (8.46 ± 1.1 vs 8.55 ± 1.1, P = 0.59), mean corpuscular volume (91.0 ± 10.6 vs 91.7 ± 9.5, P = 0.67), or absolute neutrophil count (4.85 ± 2.3 vs 4.87 ± 2.3, P = 0.95) when comparing Birmingham versus satellite clinics. We also identified no difference in hospital admissions (0.99 ± 0.1 versus 0.85 ± 0.2, P = 0.49), based on clinic location. CONCLUSIONS The use of telehealth did not negatively impact laboratory response to HU. Future studies should identify novel approaches to improve access to HU among patients with SCA living in rural areas.
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Affiliation(s)
- Sarah Shaner
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Lee Hilliard
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas Howard
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brandi Pernell
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey Lebensburger
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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