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Johnson YL, Woodward K, Dampier C, Cohen L, Sil S. Biopsychosocial Factors Associated with Parenting Stress in Pediatric Sickle Cell Disease. J Clin Psychol Med Settings 2022; 29:365-374. [PMID: 34994921 PMCID: PMC9187584 DOI: 10.1007/s10880-021-09837-6] [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] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 01/11/2023]
Abstract
Caregivers of children with sickle cell disease (SCD) experience significant physical and emotional hardship with their child's disease management. Little is known about the potential contributors to parenting stress in pediatric SCD. The present study aimed to identify child and caregiver biopsychosocial factors associated with disease-related parenting stress in pediatric SCD. Participants included 74 caregiver-youth dyads. Parenting stress was associated with increased child pain frequency, more missed school days, and increased healthcare utilization, and inversely correlated with caregiver mental health and social-emotional functioning. Parenting stress also partially explained the relationship between child pain frequency and healthcare utilization after controlling for parent depression and anxiety. Parenting stress may play a unique and critical role in pediatric SCD and underscore the impact parenting stress may have on youth in medical and academic settings. Further research is warranted to determine risk factors and appropriate interventions for parenting stress to improve comprehensive patient care.
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Affiliation(s)
- Yelena L Johnson
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerri Woodward
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlton Dampier
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lindsey Cohen
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Soumitri Sil
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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Williams SA, Henson S, Trimmingham S, Newman J, Kanter J. Emergency department utilization for sickle cell disease in St. Vincent and the Grenadines. Pan Afr Med J 2021; 38:100. [PMID: 33889266 PMCID: PMC8035679 DOI: 10.11604/pamj.2021.38.100.27424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction sickle cell disease (SCD) is a chronic illness. Individuals affected by this disease are at risk for lifelong complications including episodes of acute pain, chronic pain and multi-organ injury that leads to reduced quality of life and a shortened life span. There is a wealth of data on acute care utilization for SCD in the United States. However, data from the Caribbean region is limited. The objective of this study is to explore Emergency Department (ED) utilization for SCD in St. Vincent and the Grenadines by describing: i) the characteristics of SCD related ED encounters; ii) the urgency of these encounters as defined by resource utilization; iii) the disposition for these ED encounters. Methods the study was a cross-sectional study utilizing data from the ED log books at the Milton Cato Memorial Hospital (MCMH) during non-consecutive time periods between January 1st, 2012 - December 31st, 2016. Results there were 666 SCD-related ED encounters during the study period. Thirty-four percent of encounters resulted in hospitalization and 66% of encounters met criteria for an urgent visit. The most commonly reported diagnosis was vaso-occlusive crisis and accounted for 84% of all encounters. The most frequently documented age group was the 18-30 age category at 43%. Conclusion although SCD comprised less than 2% of all ED visits, the majority of these visits could be classified as urgent visits based on resource utilization. This study adds to the emerging data on the burden of this disease in this St. Vincent and the Grenadines.
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Affiliation(s)
- Shelly-Ann Williams
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Shakel Henson
- Department of Histology, American University of St. Vincent School of Medicine, St. Vincent and the Grenadines, West Indies
| | - Shenese Trimmingham
- Department of Histology, American University of St. Vincent School of Medicine, St. Vincent and the Grenadines, West Indies
| | - Jill Newman
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Julie Kanter
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Power-Hays A, Patterson A, Sobota A. Household material hardships impact emergency department reliance in pediatric patients with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28587. [PMID: 32716125 DOI: 10.1002/pbc.28587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/11/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND In sickle cell disease (SCD), high emergency department (ED) utilization is associated with worse outcomes and increased costs. A metric called ED reliance (EDr), the percentage of healthcare visits that occur in the ED, attempts to identify ED overutilization. It is unknown if household material hardships (HMH)-housing, utility, or food insecurity-impact reliance on the ED. As these may represent modifiable risk factors for high ED utilization, we aimed to estimate the association between HMH and EDr in pediatric patients with SCD. METHODS We reviewed the electronic medical records of pediatric patients with SCD who received care in the Boston Medical Center network in Massachusetts, USA, to collect data on HMH and healthcare utilization. Using linear regression to control for potential confounders, we modeled the association between material hardships and EDr. RESULTS Of 101 eligible patients, 60 (59%) reported one or more HMH. The mean EDr was 12% overall, with significant differences between those with and without HMH (15.9 vs 5.9, P = 0.0001). Each additional hardship experienced was associated with an increased average EDr of 7.7 percentage points (R2 = 0.34, P < 0.0001). Housing and utility hardships were each independently associated with increased EDr. CONCLUSION HMH are associated with significantly increased EDr in children with SCD, independent of transportation hardship or insurance type. Through screening for HMH, providers and health systems could identify at-risk patients with modifiable risk factors for high EDr in order to provide them additional support.
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Affiliation(s)
| | - Alyssa Patterson
- Boston Medical Center, Center for the Urban Child and Healthy Family, Boston, Massachusetts
| | - Amy Sobota
- Boston Medical Center, Department of Pediatrics, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
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Social Determinants of Health and Emergency Department Use Among Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2020; 42:e42-e45. [PMID: 31743315 DOI: 10.1097/mph.0000000000001669] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sickle cell disease (SCD) is associated with disproportionate emergency department (ED) use. This study described the social determinants of health associated with ED visits and hospital admission from the ED among children with SCD using a nationally representative dataset. We analyzed data from 126 children 0 to 17 years of age with SCD included in the 2011 to 2017 rounds of the National Health Interview Survey (mean age, 8 y; 50% female individuals; 74% African American). Study variables were summarized using weighted means and proportions and compared according to ED use and admission by Wald tests. Fifty-two identified children had visited the ED within the last 12 months and 21 were admitted to the hospital after their most recent ED visit. Children living in a single-mother household were more likely to visit the ED (P=0.040), as were younger children (mean age, 6 vs. 9 y; P=0.034), with no evaluated social determinants of health significantly impacting hospital admission from the ED. The lack of association between ED use and either poverty or insurance type may be related to the overall high level of social disadvantage among children with SCD. Our findings demonstrate the need to better characterize specific social factors impacting acute care use among children with SCD.
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Longitudinal Trend in Emergency Department Reliance for Pain Among Sickle Cell Disease Patients in Wisconsin. J Pediatr Hematol Oncol 2019; 41:e438-e442. [PMID: 31219908 DOI: 10.1097/mph.0000000000001533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with sickle cell disease frequently visit the emergency department for pain. The metric of emergency department reliance (EDR) describes emergency department utilization in relation to all ambulatory visits and serves as a quality of care indicator. This study uses Wisconsin Medicaid data from 2011 to 2015 to examine trend of EDR for pain over the period of 5 years. We stratified our cohort (N=750) by patient ages into 4 groups: (1) children; (2) transition group; (3) young adults; and (4) adults. Using a linear mixed model, we estimated longitudinal trends adjusting for age group and hydroxyurea possession calculated as medication possession ratio. Results show that EDR for pain has distinct temporal patterns for each group. EDR for pediatrics continually remained less than the established threshold of 0.33. The EDR for transition group significantly increased over time; however, the EDR for young adults has significantly decreased since 2011. There were no significant differences in EDR over time for adults older than 30 years. Overall, increase in medication possession ratio was associated with lower EDR. The low EDR for pain among children and the improvements among adults indicate the success of efforts for sickle cell disease patients. However, further interventions are needed for the transition age group.
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Paulukonis ST, Feuchtbaum LB, Coates TD, Neumayr LD, Treadwell MJ, Vichinsky EP, Hulihan MM. Emergency department utilization by Californians with sickle cell disease, 2005-2014. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26390. [PMID: 28000344 PMCID: PMC5403550 DOI: 10.1002/pbc.26390] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/14/2016] [Accepted: 10/31/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Clinical care for children and adults living with sickle cell disease (SCD) is often provided in the emergency department (ED). Population-based surveillance data can be used to describe the ED utilization patterns of this patient population. PROCEDURE A cohort of pediatric and adult California patients with SCD was identified from multiple data sources, and 10 years (2005-2014) of their treat-and-release ED utilization data were analyzed. RESULTS Among a cohort of 4,636 patients with SCD, 4,100 (88%) had one or more treat-and-release ED visits. There were 2.1 mean annual visits per person for the cohort (median 0.7; range 0-185). In a single year (2005), 53% had 0 treat-and-release ED visits, 35% had 1-3 visits, 9% had 4-10 visits, and 3% had 11 or more visits; this highest utilization group accounted for 45% of all patients' ED visits. ED utilization in this cohort was highest among young adults and also higher among older adults than pediatric patients. CONCLUSION The majority of identified patients in each of the 10 years did not go to the ED, but nearly all had one or more such visits over the full span of time. This study highlights the power and utility of a multisource longitudinal data collection effort for SCD. Further study of the segment of the population with highest ED utilization may highlight areas where changes in healthcare and health policy could improve and extend the lives of patients with SCD.
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Affiliation(s)
- Susan T. Paulukonis
- California Rare Disease Surveillance Program, Public Health Institute, Richmond, California
| | - Lisa B. Feuchtbaum
- Genetic Disease Screening Program, California Department of Public Health, Richmond, California
| | - Thomas D. Coates
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital of Los Angeles, Los Angeles, California
| | - Lynne D. Neumayr
- Division of Hematology/Oncology, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, California
| | - Marsha J. Treadwell
- Division of Hematology/Oncology, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, California
| | - Elliott P. Vichinsky
- Division of Hematology/Oncology, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, California
| | - Mary M. Hulihan
- Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
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Johnson GA. Management of Sickle Cell Disease Super Utilizers. West J Emerg Med 2017; 18:251-252. [PMID: 28210360 PMCID: PMC5305133 DOI: 10.5811/westjem.2016.12.33224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/12/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gary A Johnson
- SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York
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Hsu LL, Green NS, Donnell Ivy E, Neunert CE, Smaldone A, Johnson S, Castillo S, Castillo A, Thompson T, Hampton K, Strouse JJ, Stewart R, Hughes T, Banks S, Smith-Whitley K, King A, Brown M, Ohene-Frempong K, Smith WR, Martin M. Community Health Workers as Support for Sickle Cell Care. Am J Prev Med 2016; 51:S87-98. [PMID: 27320471 PMCID: PMC4918511 DOI: 10.1016/j.amepre.2016.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/25/2022]
Abstract
Community health workers are increasingly recognized as useful for improving health care and health outcomes for a variety of chronic conditions. Community health workers can provide social support, navigation of health systems and resources, and lay counseling. Social and cultural alignment of community health workers with the population they serve is an important aspect of community health worker intervention. Although community health worker interventions have been shown to improve patient-centered outcomes in underserved communities, these interventions have not been evaluated with sickle cell disease. Evidence from other disease areas suggests that community health worker intervention also would be effective for these patients. Sickle cell disease is complex, with a range of barriers to multifaceted care needs at the individual, family/friend, clinical organization, and community levels. Care delivery is complicated by disparities in health care: access, delivery, services, and cultural mismatches between providers and families. Current practices inadequately address or provide incomplete control of symptoms, especially pain, resulting in decreased quality of life and high medical expense. The authors propose that care and care outcomes for people with sickle cell disease could be improved through community health worker case management, social support, and health system navigation. This paper outlines implementation strategies in current use to test community health workers for sickle cell disease management in a variety of settings. National medical and advocacy efforts to develop the community health workforce for sickle cell disease management may enhance the progress and development of "best practices" for this area of community-based care.
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Affiliation(s)
- Lewis L Hsu
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Nancy S Green
- Department of Pediatrics, Columbia University, New York, New York.
| | - E Donnell Ivy
- Health Resources and Services Administration, Rockville, Maryland
| | - Cindy E Neunert
- Department of Pediatrics, Columbia University, New York, New York
| | - Arlene Smaldone
- Department of Pediatrics, Columbia University, New York, New York
| | - Shirley Johnson
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Sheila Castillo
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Amparo Castillo
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Trevor Thompson
- Sickle Cell Disease Foundation of Tennessee, Memphis, Tennessee
| | - Kisha Hampton
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - John J Strouse
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rosalyn Stewart
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - TaLana Hughes
- Sickle Cell Disease Association of Illinois, Chicago, Illinois
| | - Sonja Banks
- Sickle Cell Disease Association of America, Baltimore, Maryland
| | - Kim Smith-Whitley
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison King
- Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Mary Brown
- Sickle Cell Disease Foundation of California, Los Angeles, California
| | - Kwaku Ohene-Frempong
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wally R Smith
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Molly Martin
- Department of Pediatrics, University of Illinois, Chicago, Illinois
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Rattler TL, Walder AM, Feng H, Raphael JL. Care Coordination for Children With Sickle Cell Disease: A Longitudinal Study of Parent Perspectives and Acute Care Utilization. Am J Prev Med 2016; 51:S55-61. [PMID: 27320467 PMCID: PMC4916339 DOI: 10.1016/j.amepre.2016.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/13/2016] [Accepted: 01/27/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Care coordination (CC), a core element of the medical home, has the potential to reduce fragmented care and improve patient experience for children with sickle cell disease (SCD). This study aimed to (1) assess CC for pediatric SCD and (2) determine its association with acute care utilization-emergency department encounters and hospitalizations. It was hypothesized that CC would reduce acute care utilization. METHODS A longitudinal study of 101 children with SCD was conducted. Parents completed a survey instrument on enrollment. Utilization chart review was conducted 9 months post survey. Outcome variables were emergency department encounters and hospitalizations. Independent variables were parent-reported CC, satisfaction with communication between healthcare providers, and satisfaction with communication between healthcare providers and non-medical providers (e.g., schools, child care centers). Multivariate negative binomial regression was conducted to assess associations between CC and acute care utilization. Data were collected in 2011-2013 and analyzed in 2015. RESULTS One third of children had emergency department encounters and 30% had hospitalizations. At enrollment, 25% of parents reported receiving CC help and 20% reported need for extra CC. Most parents were satisfied with communication between physicians but only two thirds were satisfied with communication between their healthcare providers and non-medical providers. No significant associations were found between CC measures and acute care utilization. CONCLUSIONS Although parents report multiple CC deficiencies, no associations were found between CC and acute care utilization. Population-based studies are warranted to more definitively determine the association between CC and acute care utilization for children with SCD.
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Affiliation(s)
- Tiffany L Rattler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas;.
| | - Annette M Walder
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hua Feng
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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