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Benini F, Brogelli L, Mercante A, Giacomelli L. Transition to Adulthood in Pediatric Palliative Care: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:860. [PMID: 39062309 PMCID: PMC11276494 DOI: 10.3390/children11070860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
Pediatric palliative care (PPC) is defined as "the active care of the child's body, quality of life, mind and spirit, also giving support to the family". PPC should be established once a diagnosis of life-limiting or life-threatening disease is reached and should continue as long as necessary. Therefore, pediatric palliative care (PPC) can continue for years, also given the improved care approaches for children with life-limiting or life-threatening diseases. Over time, the child may grow to become a young adult, and when this happens, the transition to adult healthcare services must be undertaken. This article discusses possible interventions, fostering an efficient transition from pediatric to adult palliative care. A narrative review presents issues, experiences, and existing programs. A "Perspectives" section presents opinions and proposals by the authors. The transition process is not limited to a change from pediatric to adult services. Rather, it includes the entire process of the development of the child and requires interdisciplinary management with proper planning and collaboration among professionals of pediatric and adult teams.
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Affiliation(s)
- Franca Benini
- Pediatric Palliative Care, Pain Service, Department of Women’s and Children’s Health, University of Padua, 35122 Padua, Italy;
| | | | - Anna Mercante
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy;
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2
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Attell BK, Barrett PM, Pace BS, McLemore ML, McGee BT, Oshe R, DiGirolamo AM, Cohen LL, Snyder AB. Characteristics of Emergency Department Visits Made by Individuals With Sickle Cell Disease in the U.S., 1999-2020. AJPM FOCUS 2024; 3:100158. [PMID: 38149076 PMCID: PMC10749880 DOI: 10.1016/j.focus.2023.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Introduction Individuals living with sickle cell disease experience high levels of morbidity that result in frequent utilization of the emergency department. The objective of this study was to provide updated national estimates of emergency department utilization associated with sickle cell disease in the U.S. Methods Data from the National Hospital Ambulatory Medical Care Survey for the years 1999-2020 were analyzed. Complex survey analysis was utilized to produce national estimates overall and by patient age groups. Results On average, approximately 222,612 emergency department visits occurred annually among individuals with sickle cell disease, a nearly 13% increase from prior estimates. The annual volume of emergency department visits steadily increased over time, and pain remains the most common patient-cited reason for visiting the emergency department. Patient-reported pain levels for individuals with sickle cell disease were high, with 64% of visits associated with severe pain and 21% associated with moderate pain. Public insurance sources continue to cover most visits, with Medicaid paying for 60% of visits and Medicare paying for 12% of visits. The average time spent in the emergency department increased from previous estimates by about an hour, rising to approximately 6 hours. The average wait time to see a provider was 53 minutes. Conclusions Utilization of the emergency department by individuals living with sickle cell disease remains high, especially for pain. With more than half of patients with sickle cell disease reporting severe pain levels, emergency department staff should be prepared to assess and treat sickle cell disease-related pain following evidence-based guidelines and recommendations. The findings of this study can help improve care in this population.
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Affiliation(s)
- Brandon K. Attell
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | | | - Betty S. Pace
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Morgan L. McLemore
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Blake T. McGee
- School of Nursing, Georgia State University, Atlanta, Georgia
| | - Rewo Oshe
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia
| | - Ann M. DiGirolamo
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Lindsey L. Cohen
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia
| | - Angela B. Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
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Treadwell MJ. Mental health and psychological resilience in sickle cell disease. Lancet Haematol 2023:S2352-3026(23)00166-7. [PMID: 37451306 DOI: 10.1016/s2352-3026(23)00166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Marsha J Treadwell
- Division of Hematology, Department of Pediatrics, Sickle Cell Center of Excellence, University of California San Francisco, Oakland, CA 94609, USA.
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4
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de Beaufort C, Gomber A, Sap S, Laffel L. From paediatric to adult diabetes care: lost in transition. Lancet Diabetes Endocrinol 2023; 11:446-448. [PMID: 37209705 PMCID: PMC10851110 DOI: 10.1016/s2213-8587(23)00091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Carine de Beaufort
- Diabetes & Endocrine Care Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette 4356, Luxembourg.
| | - Apoorva Gomber
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Suzanne Sap
- Department of Paediatrics, Faculty of Medicine, University of Yaounde, Yaounde, Cameroon
| | - Lori Laffel
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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5
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Boucher AA, Lyons M, McGann PT. Rethinking Care Models for Young Adults With Sickle Cell Disease. JAMA HEALTH FORUM 2023; 4:e230877. [PMID: 37171796 DOI: 10.1001/jamahealthforum.2023.0877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
This Viewpoint discusses developing new sickle cell disease adult care models to support specialized health care homes that are patient-focused and antiracist, rather than an approach focused mainly on financial incentives.
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Affiliation(s)
- Alexander A Boucher
- Division of Pediatric Hematology and Oncology, Division of Hematology, Oncology, and Transplantation, Departments of Pediatrics and Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Margaret Lyons
- Departments of Pediatrics and Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Patrick T McGann
- Departments of Pediatrics and Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Lifespan Comprehensive Sickle Cell Center, Providence, Rhode Island
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6
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Alani ZA. Perspectives from the periphery of Paediatrics. Front Psychol 2022; 13:1044692. [PMID: 36562073 PMCID: PMC9763564 DOI: 10.3389/fpsyg.2022.1044692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
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Cunard R, Gopal S, Kopko PM, Dang MU, Hazle KM, Sanchez AP. Comprehensive guide to managing a chronic automated red cell exchange program in sickle cell disease. J Clin Apher 2022; 37:497-506. [PMID: 36172983 DOI: 10.1002/jca.22014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022]
Abstract
Sickle cell disease (SCD) is associated with significant morbidity and mortality, and limits both the quality and quantity of life. Transfusion therapy, specifically automated red cell exchange (aRCE), plays a key role in management of SCD and is beneficial for certain indications in the chronic, outpatient setting. The approach to maintain a successful chronic aRCE program for SCD is multifaceted. This review will highlight important considerations including indications for aRCE, patient selection, transfusion medicine pearls, vascular access needs, complications of therapy, aRCE prescription, and therapy optimization. Moreover, the importance of a multidisciplinary approach with frequent communication between the services involved cannot be overstated. Ultimately, the underlying goal of a chronic RCE program is to improve the quality of life and longevity of patients with SCD.
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Affiliation(s)
- Robyn Cunard
- Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Srila Gopal
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Patricia M Kopko
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | - Amber P Sanchez
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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8
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Kruger E, Voorhees K, Thomas N, Judge M, Galla J, Kung J, Rodriguez D. Understanding the impact of long-chain fatty acid oxidation disorders for patients and caregivers. Mol Genet Metab Rep 2022; 32:100903. [PMID: 36046395 PMCID: PMC9421447 DOI: 10.1016/j.ymgmr.2022.100903] [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: 04/18/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/12/2022] Open
Abstract
Long-chain fatty acid oxidation disorders (LC-FAOD) are a group of rare, autosomal recessive genetic disorders that impair conversion of long-chain fatty acids into energy. Here we describe the impact of LC-FAOD in terms of effects on work and school, absenteeism and presenteeism at work, importance of symptoms, physical activity, participation in social activities, and quality of life (QoL). A convenience sample of adults (≥18 years) and caregivers of patients with LC-FAOD was invited to take the online survey (Confirmit). To be included, patients must have been receiving medical care from a healthcare provider for their LC-FAOD, and caregivers must not have been compensated for their care. Degree of physical activity, represented by metabolic equivalents (METs), was calculated using the NHANES Physical Activity Questionnaire. Absenteeism and presenteeism at work were calculated using the WHO Health Productivity Questionnaire. QoL was assessed using the 12-Item Short Form of the Medical Outcomes Survey. Significance was assessed using two tailed independent sample t-tests and z-tests at α = 0.1. Fourteen adults and 30 caregivers of LC-FAOD patients (answering for 37 patients) answered the survey (51 unique respondents). 59.2% of LC-FAOD patients experienced effects on their schooling due to LC-FAOD. 84.2% of working patients experienced effects on their work due to LC-FAOD. 70% of caregivers experienced effects on their work due to their child's LC-FAOD. Unique respondents report that muscle weakness (69%), physical fatigue (49%), and rhabdomyolysis (39%) are the most impactful symptoms of LC-FAOD. Adults (n = 14) scored significantly below the normalized average (50) on both physical (34.51, p < 0.001) and mental (45.27, p = 0.04) component scores of the SF-12 health-related quality of life measure. LC-FAOD impart a high disease impact on patients and their caregivers. In particular, symptoms relating to energy production were rated as highly impactful and limiting. Activities that may be considered normal for many people can prove to be very difficult or impossible for respondents with LC-FAOD, with respondents reporting lower physical and mental health-related quality of life measures than the average American. LC-FAOD has a measurable impact on patient and caregiver education and employment (83/85). Muscle weakness was the most impactful symptom of LC-FAOD on individuals' lives (82/85). Physical and mental health were significantly lower in individuals with LC-FAOD (82/85).
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Affiliation(s)
| | | | - Nina Thomas
- Ultragenyx Pharmaceutical Inc., Novato, CA, USA
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Alashkar F, Aramayo-Singelmann C, Böll J, Hoferer A, Jarisch A, Kamal H, Oevermann L, Schwarz M, Cario H. Transition in Sickle Cell Disease (SCD): A German Consensus Recommendation. J Pers Med 2022; 12:jpm12071156. [PMID: 35887653 PMCID: PMC9325299 DOI: 10.3390/jpm12071156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/26/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Sickle cell disease (SCD) is considered a rare disease in Germany. Due to the increasing prevalence, the acute and chronic morbidities associated with the disease and the sharp increase in the mortality rate of young adults, a need-based transition structure for patients with SCD in Germany is explicitly required. This is the first multicenter German consensus statement addressing the importance of implementing a standardized transition guideline that allows adolescents and young adults to safely transition from pediatric to adult care. Early identification of medical needs and intervention remains important in the context of chronic diseases. Effective measures can improve health care in general, as they lead to a reduction in disease and the consequential economic burden. It is noteworthy that improving structural barriers remains a key challenge even in highly developed countries such as Germany. Inclusion of these transition services for patients with SCD into the regular care of chronically ill adolescents and young adults should be ensured, as well as the coverage of costs associated with a structured transition process.
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Affiliation(s)
- Ferras Alashkar
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Correspondence:
| | - Carmen Aramayo-Singelmann
- Department of Pediatrics III, University Children’s Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Janine Böll
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, 50923 Cologne, Germany;
| | - Annette Hoferer
- Hematology/Oncology Department for Adolescent Medicine, Robert-Bosch-Hospital, 70376 Stuttgart, Germany;
| | - Andrea Jarisch
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Haytham Kamal
- Joint Practice for Hematology and Oncology, 30625 Hannover, Germany;
| | - Lena Oevermann
- Department of Pediatric Oncology & Hematology, Charité University Medicine, 10117 Berlin, Germany;
| | - Michaela Schwarz
- Department of Hematology, Oncology, and Tumor Immunology, Charité University Medicine, 10117 Berlin, Germany;
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine & Center for Rare Hematopoietic Disorders and Immunodeficiencies (ZSHI Ulm), Ulm University Medical Center, 89069 Ulm, Germany;
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10
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X-Linked Hypophosphatemia Transition and Team Management. ENDOCRINES 2022. [DOI: 10.3390/endocrines3030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
X-linked hypophosphatemia (XLH) is the most common form of inherited disorders that are characterized by renal phosphate wasting, but it is a rare chronic disease. XLH presents in multisystemic organs, not only in childhood, but also in adulthood. Multidisciplinary team management is necessary for the care of patients with XLH. Although XLH has often been perceived as a childhood disease, recent studies have demonstrated that it is a long-term and progressive disease throughout adulthood. In the past 20 years, the importance of the transition from pediatric care to adult care for patient outcomes in adulthood in many pediatric onset diseases has been increasingly recognized. This review describes transitional care and team management for patients with XLH.
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Calhoun C, Luo L, Baumann AA, Bauer A, Shen E, McKay V, Hooley C, James A, King AA. Transition for Adolescents and Young Adults With Sickle Cell Disease in a US Midwest Urban Center: A Multilevel Perspective on Barriers, Facilitators, and Future Directions. J Pediatr Hematol Oncol 2022; 44:e872-e880. [PMID: 35731941 PMCID: PMC9218344 DOI: 10.1097/mph.0000000000002322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sickle cell disease (SCD), an inherited red blood cell disorder, primarily affects African Americans in the United States. Adolescents and young adults with SCD (AYA-SCD) are at risk of high morbidity and mortality when transitioning from pediatric to adult care. The goal of this qualitative study was to understand factors associated with optimal implementation of the AYA-SCD transition. METHODS Participants were recruited from a large hospital system and the community. Interview guides included topics on access to primary and specialized care, beliefs and practices related to pain control, transition from pediatric to adult care, and patient experiences in the emergency department. Data were coded and analyzed using an inductive thematic coding approach in combination with a deductive coding approach using domains from the Consolidated Framework for Implementation Research (CFIR). RESULTS Fifty-nine participants, including 21 AYA-SCD from both the pediatric and adult clinics, 17 caregivers, 9 pediatric SCD providers, 6 adult SCD providers, and 6 emergency department providers, completed 11 focus groups and 5 semistructured interviews. Results identified multiple factors within the domains of CFIR including the outer setting, inner setting, individual characteristics, and intervention characteristics. Results were incorporated into a transition framework to inform local practice improvement. CONCLUSION Our study highlights the importance of multilevel barriers and facilitators for AYA-SCD transition from pediatric to adult care. Future studies could use implementation science frameworks to understand local context and identify strategies and intervention characteristics to improve transition programming. These efforts will ultimately reduce health disparities and ensure health equity.
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Affiliation(s)
- Cecelia Calhoun
- Department of Pediatrics, Washington University School of Medicine
| | - Lingzi Luo
- Program in Occupational Therapy, Washington University School of Medicine
| | - Ana A. Baumann
- Washington University in St. Louis, Brown School of Social Work
| | - Anna Bauer
- Program in Occupational Therapy, Washington University School of Medicine
| | - Evelyn Shen
- Program in Occupational Therapy, Washington University School of Medicine
| | - Virginia McKay
- Washington University in St. Louis, Brown School of Social Work
| | - Cole Hooley
- Washington University in St. Louis, Brown School of Social Work
| | - Aimee James
- Division of Public Health Sciences, Washington University School of Medicine
| | - Allison A. King
- Department of Pediatrics, Washington University School of Medicine
- Program in Occupational Therapy, Washington University School of Medicine
- Division of Public Health Sciences, Washington University School of Medicine
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Transition Preparation and Satisfaction of Care Among Adolescents and Young Adults With Sickle Cell Disease at the Ghana Institute of Clinical Genetics. J Pediatr Hematol Oncol 2022; 44:e682-e688. [PMID: 35319508 DOI: 10.1097/mph.0000000000002316] [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] [Received: 02/18/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
Expanding services in Ghana for people with sickle cell disease is expected to increase childhood survival and need for transition to adult care. Little is known about patient transition experiences in sub-Saharan Africa. We sought to understand those experiences of adolescents and young adults at an adult sickle cell clinic in Accra, Ghana. Individuals 13 to 22 years of age receiving sickle cell care at the Ghana Institute of Clinical Genetics were interviewed to recall their advance preparation and early experiences in adult sickle cell clinic. Mean age of the 100 participants interviewed was 17.9±2.9 years, 65% female. Most had hemoglobin SS (77%) or hemoglobin SC (20%). Twenty-nine participants recalled pretransition preparation; 93% of them (27) had received care at Korle Bu Pediatric Sickle Cell Clinic. Among the remaining 71 who did not recall advance preparation, 54% (34) had received pediatric care at that clinic (P<0.001). More in the group recalling preparation had positive feelings about needing to transition care compared with those not recollecting preparation (55% vs. 32%, P=0.04). Our results suggest that pretransition preparation may ease the peritransition experience. Conduct and evaluation of a program for transitioning into adult sickle cell care in Ghana may facilitate the transfer process.
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Dahir K, Dhaliwal R, Simmons J, Imel EA, Gottesman GS, Mahan JD, Prakasam G, Hoch AI, Ramesan P, Díaz-González de Ferris M. Health Care Transition From Pediatric- to Adult-Focused Care in X-linked Hypophosphatemia: Expert Consensus. J Clin Endocrinol Metab 2022; 107:599-613. [PMID: 34741521 PMCID: PMC8852209 DOI: 10.1210/clinem/dgab796] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Indexed: 12/02/2022]
Abstract
CONTEXT X-linked hypophosphatemia (XLH) is an inherited skeletal disorder that can lead to lifelong deleterious musculoskeletal and functional consequences. Although often perceived as a childhood condition, children and adults both experience the negative effects of XLH. Adolescents and young adults (AYAs) benefit from effective health care transition (HCT) preparation to support the transfer from pediatric- to adult-focused care. Whereas transition timelines, milestones, and educational tools exist for some chronic conditions, they do not meet the unique needs of patients with XLH. EVIDENCE ACQUISITION To produce the first expert recommendations on HCT preparation for AYAs with XLH developed by clinical care investigators and transition experts, a formal literature search was conducted and discussed in an advisory board meeting in July 2020. A modified Delphi method was used to refine expert opinion and facilitate a consensus position. EVIDENCE SYNTHESIS We identified the need for psychosocial and access-related resources for disease education, genetic counseling, family planning, and AYA emancipation from caregiver-directed care. Additionally, we recognized that it is necessary to facilitate communication with patients through channels familiar and accessible to AYAs and teach patients to advocate for their health care/access to specialists. CONCLUSION Clear HCT preparation guidelines and treatment-related goals are defined. Individualized timelines and practical strategies for HCT preparation are proposed to optimize health outcomes resulting from continuous clinical care throughout the patient lifecycle. We provide an expert consensus statement describing a tailored HCT preparation program specifically for AYAs with XLH to aid in the effective transfer from pediatric- to adult-focused health care.
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Affiliation(s)
- Kathryn Dahir
- Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
- Correspondence: Kathryn Dahir, MD, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S, Ste 8210, Nashville, TN 37232, USA.
| | - Ruban Dhaliwal
- SUNY Upstate Medical University, Syracuse, New York 13210, USA
| | - Jill Simmons
- Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Erik A Imel
- Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Gary S Gottesman
- Shriners Hospitals for Children–St Louis, St Louis, Missouri 63110,USA
| | - John D Mahan
- Nationwide Children’s Hospital, Columbus, Ohio 43205, USA
| | | | - Allison I Hoch
- Ultragenyx Pharmaceutical Inc, Novato, California 94949, USA
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Mulchan SS, Hinderer KA, Walsh J, McCool A, Becker J. Feasibility and use of a transition process planning and communication tool among multiple subspecialties within a pediatric health system. J SPEC PEDIATR NURS 2022; 27:e12355. [PMID: 34379862 DOI: 10.1111/jspn.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE An emerging need to improve health care transition planning has developed worldwide as more youth with special health care needs are surviving to adulthood. Nurses have been instrumental in facilitating transition planning and supporting youth throughout this process. While various transition tools have been developed, health professionals' utilization and perception of these tools have yet to be explored. Furthermore, there are no universally-accepted documentation tools for transition planning. The purpose of this study was to develop and implement a transition process planning and communication tool to facilitate transition planning among multiple, pediatric subspecialties within a system-wide transition program. DESIGN AND METHODS This project was a cross-sectional quality improvement initiative. Eligible encounters in the electronic medical record (N = 20,645) were obtained from 38 subspecialty clinics at a large, freestanding pediatric health system. Transition planning documentation was monitored for 8 months pre-implementation and 14 months post-implementation of the tool. Health professionals (N = 89) completed a survey to assess the tool's feasibility. RESULTS Implementation of the tool was feasible and corresponded with increased transition planning documentation post-implementation. Nurses represented 33% of the sample that utilized the tool. Survey results revealed barriers to documentation and utilization of the tool, along with strategies for improvement. PRACTICE IMPLICATIONS This study demonstrates that health professionals, especially pediatric nurses and nurse practitioners, are willing to adopt new, electronic documentation tools to enhance multidisciplinary transition planning consistent with best practices. Future studies should address identified barriers, assess the effectiveness of the tool on improving transition outcomes, and consider implications for integration into global health care models. System-wide implementation of such tools may improve multidisciplinary communication and coordination of care for youth with special health care needs.
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Affiliation(s)
- Siddika S Mulchan
- Department of Psychiatry and Psychology, Children's Health, Dallas, Texas, USA.,Connecticut Children's, Hartford, Connecticut, USA.,University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Katherine A Hinderer
- Connecticut Children's, Hartford, Connecticut, USA.,University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jennifer Walsh
- Department of Primary Care and General Pediatrics, Children's Health, Dallas, Texas, USA
| | - Ashley McCool
- Office of Transition, Children's Health, Dallas, Texas, USA
| | - Jamie Becker
- Department of Psychiatry and Psychology, Children's Health, Dallas, Texas, USA
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15
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Gallagher ME, Chawla A, Brady BL, Badawy SM. Heterogeneity of the long-term economic burden of severe sickle cell disease: a 5-year longitudinal analysis. J Med Econ 2022; 25:1140-1148. [PMID: 36222016 DOI: 10.1080/13696998.2022.2133824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a lifelong burdensome disorder of heterogenic expression. This study investigated the longer-term economic burden of severe presentation of SCD. As SCD treatment landscapes evolve toward curative intent gene therapies, understanding how SCD-associated costs may change over the patient lifetime will be important for medical decision-making. METHODS Patients with severe presentation of SCD (presence of acute vaso-occlusive events [VOEs] or history of stroke and/or other disease-related sequelae), were identified within the MarketScan Commercial and Medicare Supplemental and Multi-state Medicaid Databases from 1/1/2010 to 12/31/2018. The first SCD claim served as the index date and patients were followed over a 5-year post-period. Clinical characteristics and healthcare resource utilization and costs were assessed over follow-up for eligible cohorts of commercial and Medicaid patients with severe SCD presentation and age-based subgroups (<18, 18-30, and ≥31). RESULTS A total of 4,487 patients, primarily insured via Medicaid (79.2%), qualified for the analysis. Patients evidenced persistent VOEs over follow-up; prevalence of most comorbidities increased with age. Mean total healthcare costs over the 5-year follow-up were $275,143 (SD± $406,770) and $362,728 (SD± $620,189) in the commercial and Medicaid samples, respectively. Disease severity, assessed by the number of VOEs and utilization of inpatient and emergency services, peaked in the 18-30 year group in both samples. These groups also evidenced the highest mean healthcare costs over the 5-year follow-up at $344,776 (SD± $434,521) and $671,321 (SD± $938,764) in the commercial and Medicaid samples respectively. CONCLUSION Results indicate high clinical need and economic burden among patients with severe presentation of SCD. These findings not only highlight the need for improved therapeutic options to limit or prevent disease progression, but also start to provide insight on lifetime costs of SCD that will be needed in the evaluation of emerging curative intent therapies.
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Affiliation(s)
| | | | | | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Perazzo D, Moore R, Kasparian NA, Rodts M, Horowitz-Kraus T, Crosby L, Turpin B, Beck AF, Hutton J. Chronic pediatric diseases and risk for reading difficulties: a narrative review with recommendations. Pediatr Res 2022; 92:966-978. [PMID: 35121848 PMCID: PMC9586865 DOI: 10.1038/s41390-022-01934-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022]
Abstract
Literacy is a major social determinant of health, rooted in skills that develop during early childhood. Children arriving at kindergarten unprepared to learn to read are more likely to have low reading proficiency thereafter. General and health literacy are highly correlated, affecting understanding of health conditions, treatment adherence, and transition to self-care and adult healthcare services. The American Academy of Pediatrics (AAP) recommends literacy and school readiness promotion during well-visits and neurodevelopmental surveillance is emphasized across primary and subspecialty care. While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and chronic medical conditions are less appreciated and under-researched. This review applies an eco-bio-developmental framework to explore literacy across five complex chronic conditions affecting millions of children worldwide: asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease. In each, integration of an efficient reading brain network may be impacted by direct factors, such as ischemia, anesthesia, and/or medications, and also indirect factors, such as altered parent-child routines, hospital stays, and missed school. By integrating literacy into care management plans for affected children, pediatric primary care and specialty providers are poised to identify risks early, target guidance and interventions, and improve academic and health outcomes. IMPACT: While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and/or chronic medical conditions such as asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease are substantial, less appreciated, and under-researched. General and health literacy are highly correlated, with implications for the understanding one's health condition, treatment adherence, and transitioning to self-care, which is especially important for children with complex and/or chronic illness. Pediatric primary care and specialty providers are poised to integrate reading and literacy into care management plans for children with complex and/or chronic illness, including early screening, guidance, support, and interventions.
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Affiliation(s)
- Donna Perazzo
- grid.24827.3b0000 0001 2179 9593Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Ryan Moore
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Nadine A. Kasparian
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Megan Rodts
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Tzipi Horowitz-Kraus
- grid.24827.3b0000 0001 2179 9593Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.6451.60000000121102151Educational Neuroimaging Center, Faculty of Education in Science and Technology and Faculty of Biomedical Engineering, Technion, Haifa, Israel
| | - Lori Crosby
- grid.24827.3b0000 0001 2179 9593Center for Clinical and Translational Science and Training and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Brian Turpin
- grid.24827.3b0000 0001 2179 9593Division of Oncology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Andrew F. Beck
- grid.24827.3b0000 0001 2179 9593Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - John Hutton
- Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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17
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Viola A, Porter J, Shipman J, Brooks E, Valrie C. A scoping review of transition interventions for young adults with sickle cell disease. Pediatr Blood Cancer 2021; 68:e29135. [PMID: 34089222 PMCID: PMC8316342 DOI: 10.1002/pbc.29135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/18/2021] [Accepted: 05/08/2021] [Indexed: 11/06/2022]
Abstract
Standardized programming for individuals with sickle cell disease (SCD) transitioning from pediatric to adult-centered care does not currently exist, resulting in high rates of mortality and morbidity. This scoping review examines and evaluates the current literature on SCD transition programs and interventions. Eligible studies described an existing program for individuals with SCD aged 12-29 years preparing to transition. The Evidence Project risk-of-bias tool was used to assess article quality. We identified 30 eligible articles, of which, only two were randomized controlled trials. Many studies have incomplete reports of feasibility information, such as completion rates, patient characteristics, and attrition; all studies were limited to a single institution; and most studies were rated high for risk of bias. Progress has been made in designing and gathering initial evaluation data for SCD transition programs; however, there is a need for higher quality studies, consistent assessment, and better dissemination of programs.
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Affiliation(s)
- Adrienne Viola
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jerlym Porter
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Ellen Brooks
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Cecilia Valrie
- Virginia Commonwealth University, Richmond, Virginia, USA
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18
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Nayak S, Tammara B, Harnisch LO. Population Pharmacokinetic Analysis of Rivipansel in Healthy Subjects and Subjects with Sickle Cell Disease. Drugs R D 2021; 21:217-229. [PMID: 33993463 PMCID: PMC8206303 DOI: 10.1007/s40268-021-00346-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sickle cell disease is an inherited blood disorder with reduced blood-carrying capacity. It is associated with a tendency to form microclots in blood vessels, leading to painful episodes known as a vaso-occlusive crisis. Rivipansel is a pan-selectin inhibitor being studied for the treatment of a vaso-occlusive crisis in patients with sickle cell disease. Methods A population pharmacokinetic model of rivipansel plasma and urine concentrations was constructed using a two-compartment model and data from nine different clinical studies. Creatinine clearance was calculated using the Schwartz formula for children and the Chronic Kidney Disease Epidemiology Collaboration formula for adults. Urine volume and concentration of the study drug in urine from subjects in five clinical studies were used to estimate renal and nonrenal clearance. Results Rivipansel drug concentrations were well described by the model. The post hoc estimates of average steady-state concentrations were predicted to be similar for the adult and pediatric cohorts of the pivotal phase III study. Parameter estimates showed almost exclusively renal excretion of rivipansel, which is consistent with the known properties of the drug. Conclusions The pharmacokinetics of rivipansel was well characterized by a two-compartment population pharmacokinetic model. Our results illustrate the important role of simulations in optimizing a potential drug dosing regimen for patients with sickle cell disease and progressive renal impairment. Supplementary Information The online version contains supplementary material available at 10.1007/s40268-021-00346-3.
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Affiliation(s)
| | | | - Lutz O Harnisch
- Pfizer Ltd, London, UK. .,Global Clinical Pharmacology, Pfizer Inc., IPC096, Ramsgate Road, Sandwich, Kent, CT13 9NJ, UK.
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19
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Isokpehi RD, Johnson CP, Tucker AN, Gautam A, Brooks TJ, Johnson MO, Cozart T, Wathington DJ. Integrating Datasets on Public Health and Clinical Aspects of Sickle Cell Disease for Effective Community-Based Research and Practice. Diseases 2020; 8:E39. [PMID: 33114600 PMCID: PMC7709136 DOI: 10.3390/diseases8040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/11/2020] [Accepted: 10/20/2020] [Indexed: 11/22/2022] Open
Abstract
Sickle cell disease (SCD) is a genetic disease that has multiple aspects including public health and clinical aspects. The goals of the research study were to (1) understand the public health aspects of sickle cell disease, and (2) understand the overlap between public health aspects and clinical aspects that can inform research and practice beneficial to stakeholders in sickle cell disease management. The approach involved the construction of datasets from textual data sources produced by experts on sickle cell disease including from landmark publications published in 2020 on sickle cell disease in the United States. The interactive analytics of the integrated datasets that we produced identified that community-based approaches are common to both public health and clinical aspects of sickle cell disease. An interactive visualization that we produced can aid the understanding of the alignment of governmental organizations to recommendations for addressing sickle cell disease in the United States. From a global perspective, the interactive analytics of the integrated datasets can support the knowledge transfer stage of the SICKLE recommendations (Skills transfer, Increasing self-efficacy, Coordination, Knowledge transfer, Linking to adult services, and Evaluating readiness) for effective pediatric to adult transition care for patients with sickle cell disease. Considering the increased digital transformations resulting from the COVID-19 pandemic, the constructed datasets from expert recommendations can be integrated within remote digital platforms that expand access to care for individuals living with sickle cell disease. Finally, the interactive analytics of integrated expert recommendations on sickle cell disease management can support individual and team expertise for effective community-based research and practice.
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Affiliation(s)
- Raphael D. Isokpehi
- Center for Trans-Disciplinary Data Analytics, Bethune-Cookman University, Daytona Beach, FL 32114, USA; (A.N.T.); (A.G.); (T.J.B.)
| | - Chomel P. Johnson
- Master of Public Health Program, Bethune-Cookman University, Daytona Beach, FL 32114, USA; (C.P.J.); (M.O.J.); (T.C.); (D.J.W.)
- Health Equity Internship Program, Association of State Public Health Nutritionists, P.O. Box 37094, Tucson, AZ 85740, USA
| | - Ashley N. Tucker
- Center for Trans-Disciplinary Data Analytics, Bethune-Cookman University, Daytona Beach, FL 32114, USA; (A.N.T.); (A.G.); (T.J.B.)
| | - Aakriti Gautam
- Center for Trans-Disciplinary Data Analytics, Bethune-Cookman University, Daytona Beach, FL 32114, USA; (A.N.T.); (A.G.); (T.J.B.)
| | - Taylor J. Brooks
- Center for Trans-Disciplinary Data Analytics, Bethune-Cookman University, Daytona Beach, FL 32114, USA; (A.N.T.); (A.G.); (T.J.B.)
| | - Matilda O. Johnson
- Master of Public Health Program, Bethune-Cookman University, Daytona Beach, FL 32114, USA; (C.P.J.); (M.O.J.); (T.C.); (D.J.W.)
- Health Equity Internship Program, Association of State Public Health Nutritionists, P.O. Box 37094, Tucson, AZ 85740, USA
| | - Thometta Cozart
- Master of Public Health Program, Bethune-Cookman University, Daytona Beach, FL 32114, USA; (C.P.J.); (M.O.J.); (T.C.); (D.J.W.)
- Health Equity Internship Program, Association of State Public Health Nutritionists, P.O. Box 37094, Tucson, AZ 85740, USA
- Department of Public Health and Health Equity, Bethune-Cookman University, Daytona Beach, FL 32114, USA
| | - Deanna J. Wathington
- Master of Public Health Program, Bethune-Cookman University, Daytona Beach, FL 32114, USA; (C.P.J.); (M.O.J.); (T.C.); (D.J.W.)
- Department of Public Health and Health Equity, Bethune-Cookman University, Daytona Beach, FL 32114, USA
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20
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Inusa BPD, Jacob E, Dogara L, Anie KA. Racial inequalities in access to care for young people living with pain due to sickle cell disease. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 5:7-9. [PMID: 33065000 DOI: 10.1016/s2352-4642(20)30318-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Baba Psalm Duniya Inusa
- Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London SE1 7EH, UK; Women's and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Eufemia Jacob
- Department of Paediatric Haematology, UCLA School of Nursing, Los Angeles, CA, USA
| | - Livingstone Dogara
- Department of Haematology, Faculty of Basic Clinical Sciences, Kaduna State University College of Medicine, Kaduna, Nigeria
| | - Kofi A Anie
- Haematology and Sickle Cell Centre, Central Middlesex Hospital, London North West University Healthcare NHS Trust, London, UK; Faculty of Medicine, Imperial College London, London, UK
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