1
|
Prince EJ, Feder KJ, Calhoun C, Lee AI, Carroll CP, Restrepo V, Van Doren L. Trainees' perspectives on sickle cell education: a qualitative needs assessment. BMC MEDICAL EDUCATION 2024; 24:715. [PMID: 38956512 PMCID: PMC11220977 DOI: 10.1186/s12909-024-05696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Sickle cell disease (SCD) exemplifies many of the social, racial, and healthcare equity issues in the United States. Despite its high morbidity, mortality, and cost of care, SCD has not been prioritized in research and clinical teaching, resulting in under-trained clinicians and a poor evidence base for managing complications of the disease. This study aimed to perform a needs assessment, examining the perspectives of medical trainees pursuing hematology/oncology subspecialty training regarding SCD-focused education and clinical care. METHOD Inductive, iterative thematic analysis was used to explore qualitative interviews of subspecialty hematology-oncology trainees' attitudes and preferences for education on the management of patients with SCD. Fifteen trainees from six programs in the United States participated in 4 focus groups between April and May 2023. RESULTS Thematic analysis resulted in 3 themes: 1. Discomfort caring for patients with SCD. 2. Challenges managing complications of SCD, and 3. Desire for SCD specific education. Patient care challenges included the complexity of managing SCD complications, limited evidence to guide practice, and healthcare bias. Skill-building challenges included lack of longitudinal exposure, access to expert clinicians, and didactics. CONCLUSIONS Variations in exposure, limited formal didactics, and a lack of national standardization for SCD education during training contributes to trainees' discomfort and challenges in managing SCD, which in turn, contribute to decreased interest in entering the SCD workforce. The findings underscore the need for ACGME competency amendments, dedicated SCD rotations, and standardized didactics to address the gaps in SCD education.
Collapse
Affiliation(s)
- Elizabeth J Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. - Meyer 112, Baltimore, MD, 21287, USA
| | - Katherine J Feder
- Department of Medicine, Yale School of Medicine, 333 Cedar Street - Room WW201, New Haven, 06520, CT, USA
| | - Cecelia Calhoun
- Department of Medicine, Yale School of Medicine, 333 Cedar Street - Room WW201, New Haven, 06520, CT, USA
- Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Alfred I Lee
- Department of Medicine, Yale School of Medicine, 333 Cedar Street - Room WW201, New Haven, 06520, CT, USA
- Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. - Meyer 112, Baltimore, MD, 21287, USA
| | - Valentina Restrepo
- Department of Medicine, Yale School of Medicine, 333 Cedar Street - Room WW201, New Haven, 06520, CT, USA
- Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Layla Van Doren
- Department of Medicine, Yale School of Medicine, 333 Cedar Street - Room WW201, New Haven, 06520, CT, USA.
- Section of Hematology, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
2
|
Patel PN, Dombkowski KJ, Madden B, Raphael JL, Plegue M, Braun TM, Reeves SL. Patterns of primary and specialty care among children with sickle cell anemia. Pediatr Blood Cancer 2024; 71:e31048. [PMID: 38693643 DOI: 10.1002/pbc.31048] [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: 12/07/2023] [Revised: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND OBJECTIVE National guidelines recommend that children with sickle cell anemia (SCA) be seen regularly by primary care providers (PCPs) as well as hematologists to receive comprehensive, multidisciplinary care. The objective is to characterize the patterns of primary and hematology care for children with SCA in Michigan. METHODS Using validated claims definitions, children ages 1-17 years with SCA were identified using Michigan Medicaid administrative claims from 2010 to 2018. We calculated the number of outpatient PCP and hematologist visits per person-year, as well as the proportion of children with at least one visit to a PCP, hematologist, or both a PCP and hematologist annually. Negative binomial regression was used to calculate annual rates of visits for each provider type. RESULTS A total of 875 children contributed 2889 person-years. Of the total 22,570 outpatient visits, 52% were with a PCP and 34% with a hematologist. Annually, 87%-93% of children had a visit with a PCP, and 63%-85% had a visit with a hematologist. Approximately 66% of total person-years had both visit types within a year. The annual rate ranged from 2.3 to 2.5 for hematologist visits and from 3.7 to 4.1 for PCP visits. CONCLUSIONS Substantial gaps exist in the receipt of annual hematology care. Given that the majority of children with SCA see a PCP annually, strategies to leverage primary care visits experienced by this population may be needed to increase receipt of SCA-specific services.
Collapse
Affiliation(s)
- Pooja N Patel
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin J Dombkowski
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian Madden
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas, USA
| | - Melissa Plegue
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas M Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah L Reeves
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Reeves SL, Plegue M, Patel PN, Paulukonis ST, Horiuchi SS, Zhou M, Attell BK, Pace BS, Snyder AB, Plaxco AP, Mukhopadhyay A, Smeltzer MP, Ellimoottil CS, Hulihan M. Assessing Patterns of Telehealth Use Among People with Sickle Cell Disease Enrolled in Medicaid During the Start of the COVID-19 Pandemic. Telemed J E Health 2024; 30:e1971-e1979. [PMID: 38603584 PMCID: PMC11257828 DOI: 10.1089/tmj.2023.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Background: Telehealth can be defined as using remote technologies to provide health care. It may increase access to care among people with sickle cell disease (SCD). This study examined (1) telehealth use, (2) characteristics of telehealth use, and (3) differences between telehealth users and nonusers among people with SCD during the COVID-19 pandemic. Methods: This was a retrospective analysis of Medicaid claims among four states [California (CA), Georgia (GA), Michigan (MI), Tennessee (TN)] participating in the Sickle Cell Data Collection program. Study participants were individuals ≥1 year old with SCD enrolled in Medicaid September 2019-December 2020. Telehealth encounters during the pandemic were characterized by provider specialty. Health care utilization was compared between those who did (users) and did not (nonusers) use telehealth, stratified by before and during the pandemic. Results: A total of 8,681 individuals with SCD (1,638 CA; 3,612 GA; 1,880 MI; and 1,551 TN) were included. The proportion of individuals with SCD that accessed telehealth during the pandemic varied across states from 29% in TN to 80% in CA. During the pandemic, there was a total of 21,632 telehealth encounters across 3,647 users. In two states (MI and GA), over a third of telehealth encounters were with behavioral health providers. Telehealth users had a higher average number of health care encounters during the pandemic: emergency department (pooled mean = 2.6 for users vs. 1.5 for nonusers), inpatient (1.2 for users vs. 0.6 for nonusers), and outpatient encounters (6.0 for users vs. 3.3 for nonusers). Conclusions: Telehealth was frequently used at the beginning of the COVID-19 pandemic by people with SCD. Future research should focus on the context, facilitators, and barriers of its implementation in this population.
Collapse
Affiliation(s)
- Sarah L. Reeves
- Department of Pediatrics, Susan B. Meister Child Health
Evaluation and Research Center, Medical School, University of Michigan, Ann Arbor,
Michigan, USA
- Department of Epidemiology, School of Public Health,
University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa Plegue
- Department of Pediatrics, Susan B. Meister Child Health
Evaluation and Research Center, Medical School, University of Michigan, Ann Arbor,
Michigan, USA
| | - Pooja N. Patel
- Department of Pediatrics, Susan B. Meister Child Health
Evaluation and Research Center, Medical School, University of Michigan, Ann Arbor,
Michigan, USA
| | - Susan T. Paulukonis
- Tracking California Program, Public Health Institute,
Oakland, California, USA
| | - Sophia S. Horiuchi
- Tracking California Program, Public Health Institute,
Oakland, California, USA
| | - Mei Zhou
- Georgia Health Policy Center, Andrew Young School of Policy
Studies, Georgia State University, Atlanta, Georgia, USA
| | - Brandon K. Attell
- Georgia Health Policy Center, Andrew Young School of Policy
Studies, Georgia State University, Atlanta, Georgia, USA
| | - Betty S. Pace
- Department of Pediatrics: Hematology/Oncology, Medical
College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Angela B. Snyder
- Georgia Health Policy Center, Andrew Young School of Policy
Studies, Georgia State University, Atlanta, Georgia, USA
| | - Allison P. Plaxco
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, Tennessee,
USA
| | - Ayesha Mukhopadhyay
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, Tennessee,
USA
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, Tennessee,
USA
| | - Chandy S. Ellimoottil
- Department of Urology, Medical School, University of
Michigan, Ann Arbor, Michigan, USA
| | - Mary Hulihan
- Division of Blood Disorders and Public Health Genomics,
National Center on Birth Defects and Developmental Disabilities, Centers for Disease
Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Mosley C, Farrell CB, Quinn CT, Shook LM. A Mixed-Methods Evaluation of a Project ECHO Program for the Evidence-Based Management of Sickle Cell Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:530. [PMID: 38791745 PMCID: PMC11120862 DOI: 10.3390/ijerph21050530] [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: 03/08/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
Sickle cell disease (SCD) is a group of chronic, genetic disorders of the red blood cells with significant gaps in access to evidence-based clinical care. Sickle Treatment and Outcomes Research in the Midwest (STORM), a provider network, utilized Project ECHO (Extension for Community Health Outcomes), a telementoring model, to deliver evidence-based education about SCD management. The purpose of this mixed-methods study is to evaluate the utility of Project ECHO as an educational strategy for healthcare providers treating children and adults with SCD. Annual evaluations were administered to STORM TeleECHO participants from 2016 to 2021. Survey data showed a statistically significant change in self-reported provider confidence in the ability to provide care for adult patients with SCD; identify suitable candidates for disease-modifying therapies; and confidence to prescribe disease-modifying therapies. Participants who attended at least 10 sessions were invited to participate in a semi-structured interview. Qualitative data were analyzed using thematic analysis and several themes emerged about the benefits, including (1) increased confidence, (2) integrated best-practice care, (3) connection to provider network and access to experts, (4) high-quality educational presentations and (5) opportunities for collaboration and a sense of community. This suggests that Project ECHO is accessible and leads to increased confidence in providers caring for individuals with SCD. Overall, participant knowledge gains successfully demonstrated the utility of Project ECHO as an educational resource for providers.
Collapse
Affiliation(s)
- Cami Mosley
- Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Christina Bennett Farrell
- Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Charles T. Quinn
- Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Lisa Marie Shook
- Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| |
Collapse
|
5
|
Brown TR, Jansen MO, Rolin SA, Liu SA, Xu KY. The misuse of malingering diagnoses in individuals with sickle cell disease. Gen Hosp Psychiatry 2024; 87:157-158. [PMID: 38102021 PMCID: PMC10982992 DOI: 10.1016/j.genhosppsych.2023.12.001] [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: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Tashalee R Brown
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States of America; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States of America; Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, 4940 Children's Place, Saint Louis, MO 63110, United States of America.
| | - Madeline O Jansen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States of America; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States of America
| | - Stephanie A Rolin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States of America
| | - Shiyuan Anabeth Liu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States of America
| | - Kevin Y Xu
- John T. Milliken Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, United States of America; Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, 4940 Children's Place, Saint Louis, MO 63110, United States of America.
| |
Collapse
|
6
|
Payne JN, Gee BE. Management of Acute Sickle Cell Disease Pain. Pediatr Rev 2024; 45:26-38. [PMID: 38161155 DOI: 10.1542/pir.2022-005631] [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] [Indexed: 01/03/2024]
Abstract
Pain is a common complication of sickle cell disease. Sickle cell pain can often be effectively managed by pediatricians in outpatient and hospital settings. Acute pain management should be initiated quickly. Patients need to be evaluated for sickle cell complications and other causes of pain. Nonsteroidal anti-inflammatory drugs and opioids are the mainstay of pain treatment, but additional therapies include hydration, local pain control, muscle relaxants, and nonpharmacologic approaches. Healthy lifestyle habits and good behavioral and mental health are important for preventing and coping with sickle cell disease pain. Disease-modifying therapies, such as hydroxyurea, can help prevent sickle hemoglobin polymerization and acute pain episodes. Because sickle cell disease largely affects people who are racialized minorities in the United States, health-care providers need to be aware of how their own personal biases may affect care of these patients.
Collapse
Affiliation(s)
- Jason N Payne
- Children's Healthcare of Atlanta, Atlanta, GA
- Morehouse School of Medicine, Atlanta, GA
| | - Beatrice E Gee
- Children's Healthcare of Atlanta, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
7
|
Newman TV, Yang J, Suh K, Jonassaint CR, Kane-Gill SL, Novelli EM. Use of Disease-Modifying Treatments in Patients With Sickle Cell Disease. JAMA Netw Open 2023; 6:e2344546. [PMID: 37991760 PMCID: PMC10665975 DOI: 10.1001/jamanetworkopen.2023.44546] [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] [Received: 05/12/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
Importance Despite hydroxyurea being an established treatment for sickle cell disease (SCD), it remains underused. The recent approval of the disease-modifying treatments (DMTs) l-glutamine, crizanlizumab, and voxelotor underscores the need to understand the uptake of DMTs in the current treatment landscape. Objective To explore characteristics that may be associated with DMT use and to describe observed patterns of yearly DMT use from 2014 to 2021. Design, Setting, and Participants This cross-sectional study used administrative claims data from Optum's deidentified Clinformatics Data Mart Database from January 1, 2014, to September 30, 2021, to identify adults and children with SCD. Data were analyzed from August 1, 2022, to August 28, 2023. Exposure Use of DMTs. Main Outcomes and Measures Patient characteristics across groups with varying patterns of DMT use and yearly patterns of prescription fills for hydroxyurea, crizanlizumab, voxelotor, and l-glutamine. Results A total of 5022 beneficiaries with SCD (2081 [41.4%] aged 18-45 years; 2929 [58.3%] female) were included in sample A (144 [2.9%] inconsistent users, 274 [5.5%] incident users, 892 [17.8%] consistent users, and 3712 [73.9%] non-DMT users). Inconsistent users had a higher prevalence of vaso-occlusive crises (mean [SD], 3.7 [4.7]), splenic complications (6 of 144 [4.2%]), pulmonary complications (36 of 144 [25.0%]), kidney disease (21 of 144 [14.6%]), acute chest syndrome (18 of 144 [12.5%]), and health care visits (eg, mean [SD] inpatient visits, 7.0 [10.7]) compared with the other use groups. Non-DMT users had the lowest prevalence of vaso-occlusive crises (mean [SD], 0.8 [2.4]), acute chest syndrome (109 of 3712 [2.9%]), and inpatient (mean [SD], 2.0 [6.6]) and emergency department (mean [SD], 0.7 [3.1]) visits and the highest proportion of adults 65 years and older (593 of 3712 [16.0%]). In sample B (6387 beneficiaries with SCD), hydroxyurea use modestly increased from 428 of 2188 participants (19.6%) in 2014 to 701 of 2880 (24.3%) in 2021. Use of l-glutamine increased briefly but gradually decreased throughout the study period. In 2021, out of 2880 participants, 102 (3.5%) had at least 1 fill for crizanlizumab and 131 (4.6%) had at least 1 fill for voxelotor. Overall, total DMT use increased from 428 of 2188 participants (19.6%) in 2014 to 815 of 2880 patients (28.3%) in 2021. Conclusions and Relevance In this cross-sectional analysis of adults and children with SCD, uptake of DMTs remained low from 2014 to 2021, despite the approval of newer therapies. Notable differences in patient characteristics across varied DMT exposure types necessitate further exploration into factors that facilitate DMT use and the creation of strategies to enhance DMT uptake.
Collapse
Affiliation(s)
- Terri Victoria Newman
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jingye Yang
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kangho Suh
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Enrico M. Novelli
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
8
|
Reich J, Cantrell MA, Smeltzer SC. An Integrative Review: The Evolution of Provider Knowledge, Attitudes, Perceptions and Perceived Barriers to Caring for Patients with Sickle Cell Disease 1970-Now. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:43-64. [PMID: 35854420 DOI: 10.1177/27527530221090179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Approximately 100,000 Americans have sickle cell disease (SCD). In the USA, the majority of patients with SCD are of African descent. Due to persistent racial and ethnic disparities in healthcare in the USA, patients with SCD experience disproportionately more health inequities because of providers' implicit biases regarding patient race. Lack of access to health insurance, lack of transportation to healthcare providers, and inadequate provider knowledge contribute to the morbidity and mortality of patients with SCD. The purpose of this integrative review was to analyze and synthesize the literature on providers' knowledge, perceptions, beliefs, and attitudes toward patients with SCD. A modified (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) method was used to conduct a comprehensive review of the literature yielding 31 publications included in this review. Three connected, yet distinct areas of focus were identified: (1) providers' knowledge, attitudes, and perceptions of patients with SCD; (2) providers' perceived or true barriers to caring for patients with SCD; and (3) interventions to improve providers' attitudes, perceptions, and care of patients with SCD. In each area of focus, research has evolved over time. Also included in this integrative review is a synthesis of measurement instruments used to assess provider knowledge, attitudes, perceptions, and perceived and true barriers to caring for patients with SCD. Adolescents with SCD who are transitioning from pediatric to adult care are at a particularly high risk for morbidity and mortality, so this review focused on the many opportunities that exist to advance the healthcare for young adults with SCD to improve patient outcomes later in life. This includes improving providers' knowledge, perceptions, beliefs, and attitudes, and lessening the real or perceived barriers to care for patients with SCD.
Collapse
Affiliation(s)
- Jessie Reich
- M. Louise Fitzpatrick College of Nursing, 16196Villanova University, Villanova, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Ann Cantrell
- M. Louise Fitzpatrick College of Nursing, 16196Villanova University, Villanova, PA, USA
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, 16196Villanova University, Villanova, PA, USA
| |
Collapse
|
9
|
Price ST, Mainous AG, Rooks BJ. Survey of cancer screening practices and telehealth services among primary care physicians during the COVID-19 pandemic. Prev Med Rep 2022; 27:101769. [PMID: 35313453 PMCID: PMC8928753 DOI: 10.1016/j.pmedr.2022.101769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic resulted in rapid implementation of telehealth within primary care impacting cancer screening. We sought to assess the impact of increased telehealth use on physician recommendation for cancer screenings during the COVID-19 pandemic in North America. Primary care physicians (n = 757) were surveyed in Fall 2020 through the Council of Academic Family Medicine's Educational Research Alliance (CERA) general membership survey. Respondents were asked about cancer screening practices and telehealth services during the COVID-19 pandemic. Chi-squared tests were performed to assess relationships between cancer screening practices and changes in care necessitated by the shift to telehealth services. Associations between participant responses and those reporting a diminished patient-provider relationship were assessed with multivariable logistic regression. A substantial proportion of respondents reported postponing screening for breast (34.5%), colon (32.9%), and cervical cancer (31%), and a majority (51.1%) agreed changes in care seeking will lead to increased incidence of late stage cancer. Physicians reported high use of telehealth during the pandemic, but endorsed limitations in its use to maintain cancer screening practices and the patient-provider relationship. Physicians who reported patients were afraid to come into the office were more likely to report an impaired patient-provider relationship (OR = 2.77, 95% CI: 1.33 - 7.87). Physicians who reported that telehealth maintains their patient-provider relationship were less likely to report an impaired patient-provider relationship (OR = 0.33, 95% CI: 0.17 - 0.67). As telehealth becomes increasingly prominent, evaluation of the impact of telehealth on cancer screening and patient-provider relationships will be increasingly important for primary care.
Collapse
Affiliation(s)
- Sarah T. Price
- Department of Family Medicine, Medical University of South Carolina, 135 Cannon Street, Suite 405 MSC 192, Charleston 29425, USA
| | - Arch G. Mainous
- Department of Community Health and Family Medicine, University of Florida, 1329 SW 16 Street 4270, Gainesville 32608, USA
- Department of Health Services Research, 1225 Center Drive, University of Florida, Gainesville 32603, USA
| | - Benjamin J. Rooks
- Department of Health Services Research, 1225 Center Drive, University of Florida, Gainesville 32603, USA
| |
Collapse
|
10
|
Foster KE, Casola AR, Uzumcu Z, Wodoslawsky S, Kelly C. Outpatient maternity care and telemedicine use perceptions in the COVID-19 pandemic: a 2020 CERA survey. Women Health 2022; 62:402-411. [DOI: 10.1080/03630242.2022.2072051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Krys E. Foster
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Allison R. Casola
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Zeynep Uzumcu
- Department of Family and Community Medicine, University of California - Davis, Sacramento, California, USA
| | - Sascha Wodoslawsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina Kelly
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| |
Collapse
|
11
|
Jacob SA, Daas R, Feliciano A, LaMotte JE, Carroll AE. Caregiver experiences with accessing sickle cell care and the use of telemedicine. BMC Health Serv Res 2022; 22:239. [PMID: 35193570 PMCID: PMC8860730 DOI: 10.1186/s12913-022-07627-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with a wide range of complications. However, a multitude of barriers prevent SCD patients from receiving adequate healthcare, including difficulties with transportation and lack of provider knowledge about disease sequelae. Importantly, studies have demonstrated the benefits of telemedicine in addressing barriers to healthcare. While previous studies have identified barriers to care through quantitative methods, few studies have explored barriers which affect the pediatric SCD patient population in the Midwest, wherein the geographical landscape can prohibit healthcare access. Furthermore, few studies have established acceptability of telemedicine among caregivers and patients with SCD. METHODS This study aims to increase understanding of barriers to care and perceptions of telemedicine by caregivers of pediatric SCD patients in a medically under-resourced area in the Midwest. Researchers conducted semi-structured interviews with caregivers of children with SCD. The interviews were audio-recorded and transcribed. Thematic analyses were performed. RESULTS Researchers interviewed 16 caregivers of 15 children with SCD. Thematic analyses of the interview transcripts revealed four broad themes regarding caregiver burden/stress, both facilitators and barriers to SCD healthcare, and general thoughts on the acceptability/usefulness of telemedicine. CONCLUSION This qualitative study describes common burdens faced by caregivers of SCD, barriers to and facilitators of SCD care in the Midwest, and caregiver perceptions of the usefulness and efficacy of telemedicine for SCD care.
Collapse
Affiliation(s)
- Seethal A Jacob
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, HITS Building, 410 W. 10th St, Suite 2000A, Indianapolis, IN, 46202, USA. .,Division of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN, 46202, USA. .,Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Roua Daas
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, HITS Building, 410 W. 10th St, Suite 2000A, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Anna Feliciano
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Julia E LaMotte
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Aaron E Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, HITS Building, 410 W. 10th St, Suite 2000A, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| |
Collapse
|
12
|
Reeves SL, Patel PN, Madden B, Ng S, Creary SE, Smith D, Ellimoottil C. Telehealth Use Before and During the COVID-19 Pandemic Among Children with Sickle Cell Anemia. Telemed J E Health 2022; 28:1166-1171. [PMID: 34986030 DOI: 10.1089/tmj.2021.0132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Sickle cell anemia (SCA) is a genetic condition that predominantly affects minority populations in the United States. A lack of access to care is strongly associated with poor outcomes and quality of care among children and adolescents with SCA. The use of telehealth, which has rapidly expanded during the COVID-19 pandemic, has been shown to improve access to care for many conditions. However, the adoption of telehealth among children and adolescents with SCA is unknown. Methods: We identified children 1-17 years old with SCA continuously enrolled in Michigan Medicaid from January 2019 to December 2020. The number of in-person and telehealth outpatient visits (both urgent and routine) were summarized prepandemic (January 2019-February 2020) and during the pandemic (March 2020-December 2020); National Provider Identifier was used to identify provider specialty for telehealth visits. Results: The study population comprised 493 children with SCA with a mean age of 8.7 (±4.9) years at study entry. Prepandemic, there were 4,367 outpatient visits; 4,348 (99.6%) were in-person and 19 (0.4%) were telehealth. During the pandemic, there were 2,307 outpatient visits; 2,059 (89.3%) were in-person and 248 (10.7%) were telehealth. Telehealth visits peaked in April 2020 and declined thereafter. The majority of telehealth visits were to hematology (49%), followed by adult subspecialists (27%) and pediatrics/family medicine (14%). Discussion/Conclusions: While the overall number of outpatient visits declined during the initial months of the pandemic compared with 2019, use of telehealth rapidly increased among children and adolescents with SCA. Additional research is needed to understand patient and provider preferences for telehealth and the roles that federal and state policies can play in facilitating telehealth adoption among children and adolescents with SCA.
Collapse
Affiliation(s)
- Sarah L Reeves
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.,Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pooja N Patel
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian Madden
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Sophia Ng
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, 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
| | - Dominic Smith
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
13
|
Smeltzer MP, Howell KE, Treadwell M, Preiss L, King AA, Glassberg JA, Tanabe P, Badawy SM, DiMartino L, Gibson R, Kanter J, Klesges LM, Hankins JS. Identifying barriers to evidence-based care for sickle cell disease: results from the Sickle Cell Disease Implementation Consortium cross-sectional survey of healthcare providers in the USA. BMJ Open 2021; 11:e050880. [PMID: 34789492 PMCID: PMC8601067 DOI: 10.1136/bmjopen-2021-050880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Sickle cell disease (SCD) leads to chronic and acute complications that require specialised care to manage symptoms and optimise clinical results. The National Heart Lung and Blood Institute (NHLBI) evidence-based guidelines assist providers in caring for individuals with SCD, but adoption of these guidelines by providers has not been optimal. The objective of this study was to identify barriers to treating individuals with SCD. METHODS The SCD Implementation Consortium aimed to investigate the perception and level of comfort of providers regarding evidence-based care by surveying providers in the regions of six clinical centres across the USA, focusing on non-emergency care from the providers' perspective. RESULTS Respondents included 105 providers delivering clinical care for individuals with SCD. Areas of practice were most frequently paediatrics (24%) or haematology/SCD specialist (24%). The majority (77%) reported that they were comfortable managing acute pain episodes while 63% expressed comfort with managing chronic pain. Haematologists and SCD specialists showed higher comfort levels prescribing opioids (100% vs 67%, p=0.004) and managing care with hydroxyurea (90% vs 51%, p=0.005) compared with non-haematology providers. Approximately 33% of providers were unaware of the 2014 NHLBI guidelines. Nearly 63% of providers felt patients' medical needs were addressed while only 22% felt their mental health needs were met. CONCLUSIONS A substantial number of providers did not know about NHLBI's SCD care guidelines. Barriers to providing care for patients with SCD were influenced by providers' specialty, training and practice setting. Increasing provider knowledge could improve hydroxyurea utilisation, pain management and mental health support.
Collapse
Affiliation(s)
- Matthew P Smeltzer
- School of Public Health, The University of Memphis, Memphis, Tennessee, USA
| | - Kristen E Howell
- School of Public Health, The University of Memphis, Memphis, Tennessee, USA
| | - Marsha Treadwell
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Liliana Preiss
- RTI International, Research Triangle Park, Carolina, USA
| | - Allison A King
- Program in Occupational Therapy, Departments of Pediatrics, Medicine, and Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | | | - Paula Tanabe
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa DiMartino
- RTI International, Research Triangle Park, Carolina, USA
| | - Robert Gibson
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Julie Kanter
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Lisa M Klesges
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| |
Collapse
|
14
|
Kanter J, Meier ER, Hankins JS, Paulukonis ST, Snyder AB. Improving Outcomes for Patients With Sickle Cell Disease in the United States. JAMA HEALTH FORUM 2021; 2:e213467. [DOI: 10.1001/jamahealthforum.2021.3467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Julie Kanter
- Division of Hematology and Oncology, University of Alabama Birmingham, Birmingham
| | | | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Angela B. Snyder
- Georgia Health Policy Center and the Department of Public Management and Policy, Andrew Young School of Policy Studies, Georgia State University, Atlanta
| |
Collapse
|
15
|
Ibemere SO, Tanabe P, Bonnabeau E, Rains G, Eason K, Earls MF, Shah N. Awareness and Use of the Sickle Cell Disease Toolbox by Primary Care Providers in North Carolina. J Prim Care Community Health 2021; 12:21501327211049050. [PMID: 34632830 PMCID: PMC8512219 DOI: 10.1177/21501327211049050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a complex chronic blood disorder characterized by severe disease complications ideally managed by both hematologists and primary care providers (PCP's). PCP's report knowledge gaps and discomfort with SCD management. Our team developed and a decision support tool for SCD management (SCD Toolbox) based on the National Heart, Lung, and Blood Institute's SCD guidelines. We surveyed PCPs in North Carolina (NC) prior to formal dissemination to determine current co-management practices, assess toolbox acceptability, use, format preferences, and understand which algorithms would be most helpful. METHOD A 23-item baseline needs assessment survey was disseminated to PCPs throughout NC. RESULTS A total of 63 medical providers responded to the survey and of these respondents, 64% reported caring for 1 to 10 patients with SCD. Only 39% of PCPs reported regular communication with an SCD specialist. Providers reported the highest level of awareness of the pediatric and adult health maintenance tools (41% and 39% respectively) and highest use of the pediatric (26%) and adult (28%) health maintenance tools. Respondents also expressed a desire to have access to multiple toolbox formats (37%) (website, mobile app and/or paper). LIMITATIONS The use of a convenience sample and low survey response are study limitations which hinder generalizability. CONCLUSIONS PCPs rarely co-managed with a specialist, had low awareness and use of SCD toolbox, and requested multiple formats for the toolbox.
Collapse
Affiliation(s)
| | - Paula Tanabe
- Duke University School of Nursing, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | | | - Gary Rains
- Duke University School of Medicine, Durham, NC, USA
| | - Kern Eason
- Previously Community Care North Carolina, Cary, NC, USA
| | | | - Nirmish Shah
- Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
16
|
Masese RV, Crego N, Douglas C, Rains G, Bonnabeau E, DeMartino T, Shah N, Tanabe P. A Needs Assessment of Persons With Sickle Cell Disease in a Major Medical Center in North Carolina. N C Med J 2021; 82:312-320. [PMID: 34544765 PMCID: PMC10564552 DOI: 10.18043/ncm.82.5.312] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a complex disease associated with many complications and a shortened lifespan. In 2016, the National Heart, Lung and Blood Institute funded 8 centers in the United States to form the Sickle Cell Disease Implementation Consortium, with the goal of improving SCD care. The aim of our study was to describe SCD self-efficacy, pain interference, and barriers to care from the perspective of persons with SCD in the North Carolina center.METHODS Persons with SCD, aged 15 and older were recruited from a large SCD center in North Carolina. Surveys, focus groups, and interviews were completed.RESULTS Fifty-one people completed a survey, and 14 people completed an interview or focus group. Barriers identified in the survey included self-care barriers, misconceptions related to hydroxyurea (an oral medication that reduces rates of pain crisis), limited provider knowledge, and stigma. Concerning self-efficacy, participants reported that they were able to manage their pain symptoms most of the time. Pain interfered most with the ability to participate in social and day-to-day activities.Common themes from the focus groups and interviews included misconceptions about hydroxyurea, pain, provider knowledge, stigma, co-management, transportation, and insurance. Recommendations to improve care included the use of case managers, utilization of treatment guidelines, individualized pain protocols, and effective co-management by providers.LIMITATIONS Participants were recruited from 1 SCD center and may not be representative of the entire SCD population in North Carolina.CONCLUSIONS Participants described many perceived barriers to care, and their responses suggest a need for improvements in patient hydroxyurea education, provider knowledge, and care coordination.
Collapse
Affiliation(s)
- Rita V Masese
- School of Nursing, Duke University, Durham, North Carolina.
| | - Nancy Crego
- School of Nursing, Duke University, Durham, North Carolina
| | | | - Gary Rains
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Nirmish Shah
- Duke University Medical Center, Duke Health, Durham, North Carolina
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, North Carolina
| |
Collapse
|
17
|
Ofakunrin AOD, Okpe ES, Afolaranmi TO, Olaosebikan RR, Kanhu PU, Adekola K, Dami N, Sagay AS. Level of utilization and provider-related barriers to the use of hydroxyurea in the treatment of sickle cell disease patients in Jos, North-Central Nigeria. Afr Health Sci 2021; 21:765-774. [PMID: 34795734 PMCID: PMC8568227 DOI: 10.4314/ahs.v21i2.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hydroxyurea is underutilized by sickle cell health-care providers in Nigeria despite available evidence of its effectiveness in reducing the manifestations and complications of sickle cell disease (SCD). OBJECTIVES To assess the level of utilization and provider-related barriers to the use of hydroxyurea in SCD therapy in Jos, Nigeria. METHODS A cross-sectional study conducted among 132 medical doctors providing care for SCD patients. Data on sociodemographics, utilization and barriers to hydroxyurea use were obtained. The barriers were fed cumulatively into the logistic regression model as predictors of utilization. RESULTS Of the 132 care providers, 88 (67%) had been in medical practice for ≥6years. The level of utilization of hydroxyurea was 24.2%. The significant barriers that predicted the non-utilization of hydroxyurea included lack of expertise (OR=5.1; 95% CI=2.65-9.05), lack of clinical guidelines (OR=3.84; 95% CI=2.37-14.33), fear of side-effects (OR=0.50; 95% CI=0.22-0.68) and doubt about its effectiveness (OR=0.30; 95% CI=0.20-0.90). CONCLUSION The level of utilization of hydroxyurea in the treatment of SCD among the care providers is sub-optimal with the lack of expertise in its use identified as the most prominent barrier. There is an urgent need for the training of sickle cell care-providers and the development of clinical guidelines on hydroxyurea use.
Collapse
Affiliation(s)
- Akinyemi OD Ofakunrin
- Department of Paediatrics, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Edache S Okpe
- Department of Paediatrics, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Tolulope O Afolaranmi
- Department of Community Medicine, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Rasaq R Olaosebikan
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia Pennsylvania, USA
| | - Patience U Kanhu
- Department of Paediatrics, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Kehinde Adekola
- Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, USA
| | - Nantok Dami
- Department of Community Medicine, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| |
Collapse
|
18
|
Building access to care in adult sickle cell disease: defining models of care, essential components, and economic aspects. Blood Adv 2021; 4:3804-3813. [PMID: 32785684 DOI: 10.1182/bloodadvances.2020001743] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/02/2020] [Indexed: 01/25/2023] Open
Abstract
Sickle cell disease (SCD) is the most common inherited blood disorder in the United States. It is a medically and socially complex, multisystem illness that affects individuals throughout the lifespan. Given improvements in care, most children with SCD survive into adulthood. However, access to adult sickle cell care is poor in many parts of the United States, resulting in increased acute care utilization, disjointed care delivery, and early mortality for patients. A dearth of nonmalignant hematology providers, the lack of a national SCD registry, and the absence of a centralized infrastructure to facilitate comparative quality assessment compounds these issues. As part of a workshop designed to train health care professionals in the skills necessary to establish clinical centers focused on the management of adults living with SCD, we defined an SCD center, elucidated required elements of a comprehensive adult SCD center, and discussed different models of care. There are also important economic impacts of these centers at an institutional and health system level. As more clinicians are trained in providing adult-focused SCD care, center designation will enhance the ability to undertake quality improvement and compare outcomes between SCD centers. Activities will include an assessment of the clinical effectiveness of expanded access to care, the implementation of SCD guidelines, and the efficacy of newly approved targeted medications. Details of this effort are provided.
Collapse
|
19
|
Tanabe P, Blewer AL, Bonnabeau E, Bosworth HB, Clayton DH, Crego N, Earls MF, Eason K, Forlines G, Rains G, Young M, Shah N. Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:18-28. [PMID: 33829067 PMCID: PMC8016663 DOI: 10.36469/jheor.2021.21535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1 800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.
Collapse
Affiliation(s)
- Paula Tanabe
- School of Nursing, Duke University, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, USA; Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- School of Nursing, Duke University, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center (DVAMC), Durham, NC, USA
| | | | - Nancy Crego
- School of Nursing, Duke University, Durham, NC, USA
| | | | - Kern Eason
- Previously - Community Care North Carolina, Cary, NC, USA
| | | | - Gary Rains
- Duke University School of Medicine, Durham, NC, USA
| | | | - Nirmish Shah
- Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
20
|
Yearby R. Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:19-27. [PMID: 33280534 DOI: 10.1080/15265161.2020.1851811] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The genome between socially constructed racial groups is 99.5%-99.9% identical; the 0.1%-0.5% variation between any two unrelated individuals is greatest between individuals in the same racial group; and there are no identifiable racial genomic clusters. Nevertheless, race continues to be used as a biological reality in health disparities research, medical guidelines, and standards of care reinforcing the notion that racial and ethnic minorities are inferior, while ignoring the health problems of Whites. This article discusses how the continued misuse of race in medicine and the identification of Whites as the control group, which reinforces this racial hierarchy, are examples of racism in medicine that harm all us. To address this problem, race should only be used as a factor in medicine when explicitly connected to racism or to fulfill diversity and inclusion efforts.
Collapse
|
21
|
Understanding sickle cell disease: impact of surveillance and gaps in knowledge. Blood Adv 2020; 4:496-498. [PMID: 32027743 DOI: 10.1182/bloodadvances.2019001000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/20/2019] [Indexed: 01/19/2023] Open
|
22
|
Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use. J Am Board Fam Med 2020; 33:91-105. [PMID: 31907250 PMCID: PMC7942752 DOI: 10.3122/jabfm.2020.01.190143] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Sickle-cell disease (SCD) causes significant morbidity, premature mortality, and high disease burden, resulting in frequent health care use. Comanagement may improve utilization and patient adherence with treatments such as Hydroxyurea. The purpose of this study was to describe acute-care utilization in Medicaid-enrolled patients with SCD, patient factors associated with comanagement, and adherence to Hydroxyurea. METHODS Data from 2790 patients diagnosed with SCD, age 1 to 65+ years, enrolled at least 1 month in North Carolina Medicaid between March 2016 and February 2017, were analyzed. Outpatient visits were categorized as primary care, hematologist, and nonhematologist specialist. Nurse practitioners or physician assistants with unidentified specialty type or family practice were categorized separately. Comanagement was defined as a minimum of 1 primary care and 1 hematologist visit/patient during the study period. RESULTS There were notable age-related differences in utilization of health care services. Only 34.82% of the sample was comanaged. Comanagement was higher in the 1-to-9-year-old (44.88%) and 10-to-17-year-old groups (39.22%) versus the 31-to-45-year-old (30.26%) and 65+-year-old (18.75%) age groups. Age had the greatest influence (AUC = 0.599) on whether or not a patient was comanaged. Only a third of the sample (32.24%) had at least 1 Hydroxyurea (HU) prescription. Age was the most predictive factor of good HUadherence (AUC = 0.6503). Prediction by comanagement was minimal with an AUC = 0.5615. CONCLUSION Comanagement was a factor in predicting HUadherence, but further studies are needed to identify the frequency and components of comanagement needed to increase adherence and reduce acute care utilization.
Collapse
|
23
|
Abstract
In recent years, California has experienced a steady rise in Asian immigration which has led to a corresponding increased prevalence of clinically significant thalassemia in this state. As part of the Public Health Research, Education and Surveillance for Hemoglobinopathies emoglobinopathies project, a survey was developed to collect information from California providers who care for thalassemia patients in an effort to better understand their practice patterns, barriers to providing care, and educational needs. When asked about educational needs, providers most frequently expressed a desire for care and management guidelines (65.3%), health educational materials for patients (47.2%), and information on complications and clinical outcomes (32.1%). Only one quarter of providers (24.0%) reported that all of their thalassemia patients have a coordinated care plan. The increase in California thalassemia cases highlights the importance of provider knowledge to effectively serve the patients in their communities. Provider education and dissemination of treatment standards can not only improve knowledge about the disease but also increase awareness about the importance of coordinating care among a multidisciplinary team of specialists. Improvement in these areas will help achieve the overarching goal of better outcomes and quality of life for patients with thalassemia.
Collapse
|
24
|
Aboagye S, Torto M, Asah-Opoku K, Nuamah MA, Oppong SA, Samba A. Sickle Cell Education: A Survey of Antenatal Healthcare Givers. Am J Trop Med Hyg 2019; 101:684-688. [PMID: 31333164 PMCID: PMC6726940 DOI: 10.4269/ajtmh.18-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/02/2019] [Indexed: 11/07/2022] Open
Abstract
To explore the educational practices of antenatal care providers toward pregnant women with sickle cell disease (SCD) and sickle cell trait (SCT), a survey was conducted among selected doctors and midwives who provide antenatal care at the outpatient clinic of the Obstetric Department of the Korle-Bu Teaching Hospital, Accra, Ghana. The study explored their practices of screening for and patient education about SCD and SCT. Of the 102 respondents, 100(98%) stated that they were knowledgeable in the medical and genetic aspects of the disease. Regarding screening, 82(80.4%) reported mandatory screening for SCD, 9(8.8%) did not offer screening as routine, and 11(10.8%) gave patients the choice. The majority (93.1%) always informed patients when the test was positive but health-care providers less than six years experience were less likely to communicate SCT status to patients without the trait (odds ratio [OR] = 0.41, 95% CI [0.18-0.93]). Nurses/midwives were less likely to tell patients their carrier status (OR = 0.25, 95% CI [0.10-0.59]). There was also variation in referral practices for genetic counseling, with 26.5% always referring, 28.4% never doing so, and 45.1% only referring if the patient had questions. This may affect patients' awareness of this genetic condition. Therefore, continuous medical education on SCD/SCT and standardization of counseling may help inform couples' family planning choices and reduce the burden of the disease on future generation and health care.
Collapse
Affiliation(s)
- Serwah Aboagye
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, United Kingdom
| | - Magdalene Torto
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwaku Asah-Opoku
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Mercy Anna Nuamah
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Samuel Antwi Oppong
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ali Samba
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| |
Collapse
|
25
|
Shared Care for Adults with Sickle Cell Disease: An Analysis of Care from Eight Health Systems. J Clin Med 2019; 8:jcm8081154. [PMID: 31382365 PMCID: PMC6723540 DOI: 10.3390/jcm8081154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Abstract
Adult sickle cell disease (SCD) patients frequently transition from pediatric hematology to adult primary care. We examined healthcare utilization for adult patients with SCD with shared care between hematologists and primary care providers (PCP). We analyzed the OneFlorida Data Trust, a centralized data repository of electronic medical record (EMR) data from eight different health systems in Florida. The number of included adults with SCD was 1147. We examined frequent hospitalizations and emergency department (ED) visits by whether the patient had shared care or single specialty care alone. Most patients were seen by a PCP only (30.4%), followed by both PCP and hematologist (27.5%), neither PCP nor hematologist (23.3%), and hematologist only (18.7%). For patients with shared care versus single specialist care other than hematologist, the shared care group had a lower likelihood of frequent hospitalizations (OR 0.63; 95% CI 0.43-0.90). Similarly, when compared to care from a hematologist only, the shared care group had a lower likelihood of frequent hospitalizations (OR 0.67; 95% CI 0.47-0.95). There was no significant relationship between shared care and ED use. When patients with SCD have both a PCP and hematologist involved in their care there is a benefit in decreased hospitalizations.
Collapse
|
26
|
Prusty B, Soren T, Choudhury A, Biswal R, Pradhan DK, Thatoi PK. Sickle cell disease prevents diabetes mellitus occurrence: A hospital based cross-sectional study. J Family Med Prim Care 2019; 8:361-364. [PMID: 30984639 PMCID: PMC6436325 DOI: 10.4103/jfmpc.jfmpc_466_18] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sickle cell disease is the commonest inherited hemoglobinopathy. There are few reports point towards decrease incidence of diabetes mellitus in sickle cell disease patients. MATERIALS AND METHODS This cross-sectional study was conducted in VIMSAR, Burla, Odisha between Nov 2014 to Oct 2016. FBS and 2 hours OGTT reports of adult sickle cell disease patients were compared with the same reports from equal no of adult persons without sickle cell disease (controls) to found out any significant difference in prevalence of diabetes mellitus in sickle cell disease patients versus controls. RESULTS A total of 137 adult patients of sickle cell disease out of which males were 94 (68.61%) and females were 43 (31.38%) with an average age of (26.7 ± 10.9) years and an equal number of controls [males 87 (63.8%) and females 50 (36.5%)] with an average age of (47.6 ± 13.6) years were included in the study. We found diabetes mellitus in 2 (1.46%) out of 137 sickle cell disease patients with an average BMI 18.5 kg/m2 versus 12 (8.76%) in equal number of controls with an average BMI of 22.6 kg/m2. CONCLUSION This study concludes that prevalence of diabetes mellitus in sickle cell disease patients is significantly lower than non-sickle cell disease persons. This may be due to less longevity and low BMI in sickle cell disease patients.
Collapse
Affiliation(s)
- Biswaranjan Prusty
- Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Thakura Soren
- Department of Medicine, PRM Medical College, Baripada, Odisha, India
| | - Anurag Choudhury
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Reshma Biswal
- Department of Dermatology, SCB Medical College, Cuttack, Odisha, India
| | - Dillip K. Pradhan
- Department of Medicine, PRM Medical College, Baripada, Odisha, India
| | - Pravat K. Thatoi
- Department of Medicine, PRM Medical College, Baripada, Odisha, India
| |
Collapse
|
27
|
Barriers to Care for Persons With Sickle Cell Disease: The Case Manager's Opportunity to Improve Patient Outcomes. Prof Case Manag 2018; 23:213-219. [PMID: 29846351 DOI: 10.1097/ncm.0000000000000260] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE AND OBJECTIVES The purpose of this discussion is to review the barriers to care for patients with sickle cell disease (SCD). Chronic pain and the perception of addiction, implicit bias, frequent hospitalizations and emergency department visits, clinician and patient knowledge deficits, and SCD stigma all impede the ability to provide evidence-based care for patients with SCD. Case managers can coordinate and advocate for appropriate care that improves patient outcomes. PRIMARY PRACTICE SETTING This discussion is relevant to case managers working with patients with SCD in the clinic, hospital, and emergency department. FINDINGS/CONCLUSIONS Case managers can serve an important advocacy role and intervene to improve the coordination of services and efficient use of resources. This will lead to improved quality of life and optimal health care utilization for persons with SCD. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE As a constant member of the health care team, the case manager may be the only health care team member who has a broad knowledge of the patient's experience of acute and chronic pain, usual state of health, social behavioral health needs, and how these factors may affect both inpatient and outpatient health care use and health outcomes. This article explores the barriers to care and suggests specific interventions within the role of the case manager that can improve care delivered and ultimately contribute to improved patient outcomes. Specifically, these interventions can improve communication among members of the health care team. Case manager interventions can guide coordination, prevent hospital readmissions, reduce health care utilization, and contribute to overall improved patient quality of life and health outcomes.
Collapse
|
28
|
Effectiveness of Clinical Decision Support Based Intervention in the Improvement of Care for Adult Sickle Cell Disease Patients in Primary Care. J Am Board Fam Med 2018; 31:812-816. [PMID: 30201679 PMCID: PMC6153439 DOI: 10.3122/jabfm.2018.05.180106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Although most patients with rare diseases like sickle cell disease (SCD) are treated in the primary care setting, primary care physicians may find it challenging to keep abreast of medication improvements and complications associated with treatment for rare and complex diseases. The purpose of this study was to evaluate the effectiveness of a clinical decision support (CDS) -based intervention system for transfusional iron overload in adults with SCD to improve management in primary care. METHODS An electronic medical record based clinical decision support system for potential transfusional iron overload in SCD patients in primary care was evaluated. The intervention was implemented in 3 family medicine clinics with a control group of 3 general internal medicine clinics. Data were collected in the 6 months before the intervention and 6 months after the intervention. There were 47 patients in the family medicine group and 24 in the general internal medicine group. RESULTS There was no management change in the control group while the intervention group improved primary care management from 0% to 44% (P < .001). CONCLUSION A CDS tool can improve management of SCD patients in primary care.
Collapse
|
29
|
Leger RR, Wagner LD, Odesina V. Stigma in adults with sickle cell disease and family members: Scale development and pilot study in the USA and Nigeria. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
30
|
Ansari J, Moufarrej YE, Pawlinski R, Gavins FNE. Sickle cell disease: a malady beyond a hemoglobin defect in cerebrovascular disease. Expert Rev Hematol 2017; 11:45-55. [PMID: 29207881 DOI: 10.1080/17474086.2018.1407240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a devastating monogenic disorder that presents as a multisystem illness and affects approximately 100,000 individuals in the United States alone. SCD management largely focuses on primary prevention, symptomatic treatment and targeting of hemoglobin polymerization and red blood cell sickling. Areas covered: This review will discuss the progress of SCD over the last few decades, highlighting some of the clinical (mainly cerebrovascular) and psychosocial challenges of SCD in the United States. In addition, focus will also be made on the evolving science and management of this inherited disease. Expert commentary: Until recently hydroxyurea (HU) has been the only FDA approved therapy for SCD. However, advancing understanding of SCD pathophysiology has led to multiple clinical trials targeting SCD related thrombo-inflammation, abnormal endothelial biology, increased oxidant stress and sickle cell mutation. Yet, despite advancing understanding, available therapies are limited. SCD also imposes great psychosocial challenges for the individual and the affected community, which has previously been under-recognized. This has created a pressing need for complementary adjuvant therapies with repurposed and novel drugs, in addition to the establishment of comprehensive clinics focusing on both the medical treatment and the psychosocial issues associated with SCD.
Collapse
Affiliation(s)
- Junaid Ansari
- a Department of Molecular and Cellular Physiology , Louisiana State University Health Sciences Center - Shreveport , Shreveport , LA , USA
| | - Youmna E Moufarrej
- b Louisiana State University School of Medicine - Shreveport , Shreveport , LA , USA
| | - Rafal Pawlinski
- c Department of Medicine , University of North Carolina , Chapel Hill , NC , USA
| | - Felicity N E Gavins
- a Department of Molecular and Cellular Physiology , Louisiana State University Health Sciences Center - Shreveport , Shreveport , LA , USA
| |
Collapse
|
31
|
Minniti CP, Vichinsky E. Lifespan care in SCD: Whom to transition, the patients or the health care system? Am J Hematol 2017; 92:487-489. [PMID: 28211097 DOI: 10.1002/ajh.24685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Caterina P. Minniti
- Division of Hematology; Director, Sickle Cell Center, Montefiore Medical Center; 3411 Wayne Avenue, Suite A Bronx New York USA
| | - Elliott Vichinsky
- UCSF Benioff Children's Hospital Oakland; 747 52nd Street Oakland CA 94609 USA
| |
Collapse
|
32
|
Shook LM, Farrell CB, Kalinyak KA, Nelson SC, Hardesty BM, Rampersad AG, Saving KL, Whitten-Shurney WJ, Panepinto JA, Ware RE, Crosby LE. Translating sickle cell guidelines into practice for primary care providers with Project ECHO. MEDICAL EDUCATION ONLINE 2016; 21:33616. [PMID: 27887664 PMCID: PMC5124118 DOI: 10.3402/meo.v21.33616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Approximately 100,000 persons with sickle cell disease (SCD) live in the United States, including 15,000 in the Midwest. Unfortunately, many patients experience poor health outcomes due to limited access to primary care providers (PCPs) who are prepared to deliver evidence-based SCD care. Sickle Treatment and Outcomes Research in the Midwest (STORM) is a regional network established to improve care and outcomes for individuals with SCD living in Indiana, Illinois, Michigan, Minnesota, Ohio, and Wisconsin. METHODS STORM investigators hypothesized that Project ECHO® methodology could be replicated to create a low-cost, high-impact intervention to train PCPs in evidence-based care for pediatric and young adult patients with SCD in the Midwest, called STORM TeleECHO. This approach utilizes video technology for monthly telementoring clinics consisting of didactic and case-based presentations focused on the National Heart, Lung and Blood Institute (NHLBI) evidence-based guidelines for SCD. RESULTS Network leads in each of the STORM states assisted with developing the curriculum and are recruiting providers for monthly clinics. To assess STORM TeleECHO feasibility and acceptability, monthly attendance and satisfaction data are collected. Changes in self-reported knowledge, comfort, and practice patterns will be compared with pre-participation, and 6 and 12 months after participation. CONCLUSIONS STORM TeleECHO has the potential to increase implementation of the NHLBI evidence-based guidelines, especially increased use of hydroxyurea, resulting in improvements in the quality of care and outcomes for children and young adults with SCD. This model could be replicated in other pediatric chronic illness conditions to improve PCP knowledge and confidence in delivering evidence-based care.
Collapse
Affiliation(s)
- Lisa M Shook
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA;
| | - Christina B Farrell
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karen A Kalinyak
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Kay L Saving
- Children's Hospital of Illinois, OSF Saint Francis Medical Center, University of Illinois College of Medicine, Peoria, IL, USA
| | | | - Julie A Panepinto
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Russell E Ware
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lori E Crosby
- Division of Behavioral Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
33
|
Ajayi TA, Edmonds KP, Thornberry K, Atayee RA. Palliative Care Teams as Advocates for Adults with Sickle Cell Disease. J Palliat Med 2016; 19:195-201. [DOI: 10.1089/jpm.2015.0268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Toluwalase A. Ajayi
- Department of Pediatrics, Rady Children's Hospital, San Diego, California
- Scripps Translational Science Institute, La Jolla, California
| | - Kyle P. Edmonds
- Doris A. Howell Palliative Care Service, University of California San Diego, La Jolla, California
| | - Kathryn Thornberry
- Doris A. Howell Palliative Care Service, University of California San Diego, La Jolla, California
| | - Rabia A. Atayee
- Doris A. Howell Palliative Care Service, University of California San Diego, La Jolla, California
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California
| |
Collapse
|