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Prussien KV, Faust HL, Crosby LE, Smith-Whitley K, Barakat LP, Schwartz LA. The pervasive influence of systems of power on transition readiness for adult care in sickle cell disease: A qualitative study. Pediatr Blood Cancer 2024; 71:e31156. [PMID: 38953147 DOI: 10.1002/pbc.31156] [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: 01/16/2024] [Revised: 05/03/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Adolescence and young adulthood are vulnerable developmental periods for individuals with sickle cell disease (SCD), particularly given the impact of social inequities, challenges with transitioning to adult healthcare services, and increased risk for morbidity and mortality. Systems of power, such as institutionalized and interpersonal manifestations of bias, could impact SCD transfer and engagement in adult care through their influence on healthcare transition readiness; yet research in this area is limited. OBJECTIVE To characterize how systems of power impact transition readiness factors described in the Social-ecological Model of AYA Readiness for Transition to Promote Health Equity (SMART-E) framework at the patient, caregiver, and practitioner levels. METHODS Pediatric adolescents and young adults (AYA), transferred AYA, caregivers, and practitioners participated in semi-structured focus groups and individual interviews examining health equity and systems of power during healthcare transition. Focus groups/interviews were transcribed and coded using a deductive approach via the updated SMART-E framework. RESULTS Ten pediatric AYA with SCD, nine transferred AYA with SCD, eight caregivers, and nine practitioners participated in a focus group or interview. Qualitative findings across reporters emphasize the impact of systems of power (e.g., racial bias and disease stigma) on knowledge, skills and self-efficacy, beliefs and expectations, goals and motivation, and emotions and psychosocial functioning at the patient, caregiver, and practitioner levels. CONCLUSION Systems of power are prevalent with respect to transition barriers for AYA with SCD and their supports. Structural, institutional, and individual factors with potential to reduce the influence of systems of power should be further identified and targeted for intervention.
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Affiliation(s)
- Kemar V Prussien
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Haley L Faust
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lori E Crosby
- Division of Behavioral Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Kim Smith-Whitley
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pfizer, New York, New York, USA
| | - Lamia P Barakat
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisa A Schwartz
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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2
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Yates AM, Aygun B, Nuss R, Rogers ZR. Health Supervision for Children and Adolescents With Sickle Cell Disease: Clinical Report. Pediatrics 2024; 154:e2024066842. [PMID: 39034826 DOI: 10.1542/peds.2024-066842] [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: 03/27/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 07/23/2024] Open
Abstract
Sickle cell disease (SCD) is a group of complex genetic disorders of hemoglobin with multisystem manifestations. The scope of this clinical report is such that in-depth recommendations for management of all complications is not possible. Rather, the authors present an overview focused on the practical management of children and adolescents with SCD and the complications that are of particular relevance to pediatric primary care providers. References with detailed commentary provide further information. Timely and appropriate treatment of acute illness is critical, because life-threatening complications may develop rapidly. Specialized comprehensive medical care decreases morbidity and mortality during childhood. The provision of comprehensive care is a time-intensive endeavor that includes ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, nursing support, psychosocial care, and genetic counseling. Ideally, this care includes comanagement by the pediatrician or other pediatric primary care provider and a team of specialist SCD experts: Hematologist, other pediatric specialists, advanced practice providers, nurse specialists, social workers, patient navigators, and educational liaisons.
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Affiliation(s)
- Amber M Yates
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Rachelle Nuss
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Zora R Rogers
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Heath, Dallas, Texas
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Howell KE, Kayle M, Smeltzer MP, Nolan VG, Mathias JG, Nelson M, Anderson S, Porter JS, Shah N, Hankins JS. Gaps during pediatric to adult care transfer escalate acute resource utilization in sickle cell disease. Blood Adv 2024; 8:3679-3685. [PMID: 38809136 DOI: 10.1182/bloodadvances.2023011268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/30/2024] Open
Abstract
ABSTRACT Guidelines recommend transfer to adult health care within 6 months of completing pediatric care; however, this has not been studied in sickle cell disease (SCD). We hypothesized that longer transfer gaps are associated with increased resource utilization. Transfer gaps were defined as the time between the last pediatric and first adult visits. We estimated the association between varying transfer gaps and the rates of inpatient, emergency department (ED), and outpatient visits, using negative binomial regression. Health care utilization was evaluated in a mid-south comprehensive program for a follow-up period of up to 8 years (2012-2020) and was restricted to the first 2 years of adult health care. In total, 183 young adults (YAs) with SCD (51% male, 67% HbSS/HbSβ0-thalassemia) were transferred to adult health care between 2012 and 2018. YAs with transfer gaps ≥6 months compared with <2 months had 2.01 (95% confidence interval [CI], 1.31-3.11) times the rate of hospitalizations in the 8-year follow-up and 1.89 (95% CI, 1.17-3.04) when restricted to the first 2 years of adult health care. In the first 2 years of adult care, those with transfer gaps ≥6 months compared with <2 months, had 1.75 (95% CI, 1.10-2.80) times the rate of ED encounters. Those with gaps ≥2 to <6 months compared with <2 months had 0.71 (95 % CI, 0.53-0.95) times the rate of outpatient visits. Among YAs with SCD, a longer transfer gap was associated with increased inpatient and decreased outpatient encounters in adult health care and more ED encounters in the first 2 years of adult health care. Strategies to reduce the transfer gaps are needed.
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Affiliation(s)
- Kristen E Howell
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Matthew P Smeltzer
- Department of Epidemiology and Biostatistics, The University of Memphis, Memphis, TN
| | - Vikki G Nolan
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Joacy G Mathias
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Marquita Nelson
- Division of Hematology/Oncology, The University of Tennessee Health Science Center, Memphis, TN
| | - Sheila Anderson
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
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Njoku F, Pugh N, Brambilla D, Kroner B, Shah N, Treadwell M, Gibson R, Hsu LL, Gordeuk VR, Glassberg J, Hankins JS, Kutlar A, King AA, Kanter J. Mortality in adults with sickle cell disease: Results from the sickle cell disease implementation consortium (SCDIC) registry. Am J Hematol 2024; 99:900-909. [PMID: 38450756 PMCID: PMC11001513 DOI: 10.1002/ajh.27279] [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] [Received: 11/24/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
The cause of death in people affected by sickle cell disease (SCD) is often challenging to define as prior studies have used retrospective or administrative data for analysis. We used a prospective longitudinal registry to assess mortality and clinical co-morbidities among subjects enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. At enrollment, we collected the following data: patient-reported demographics, SCD phenotype, baseline laboratory values, comorbidities, and current medications. Subjects were followed for a median of 4.7 years before the present analysis. The relationship of clinical co-morbidities (at time of enrollment) to mortality was determined using survival analysis, adjusting for SCD phenotype and gender. There was a total of 2439 people with SCD enrolled in the SCDIC registry. One hundred and twenty-eight participants (5%) died during the observation period (2017-2022). Six people died from trauma and were excluded from further analysis. Proximate cause of death was unwitnessed in 17% of the deaths, but commonest causes of death include cardiac (18%), acute chest or respiratory failure (11%), sudden unexplained death (8%). Enrollment characteristics of the individuals who died (n = 122) were compared to those of survivors (n = 2317). Several co-morbidities at enrollment increased the odds of death on univariate analysis. All co-morbidities were included in a multivariable model. After backward elimination, iron overload, pulmonary hypertension, and depression, remained statistically significant predictors of the risk of death. SCD reduces life expectancy. Improved comprehensive and supportive care to prevent end-organ damage and address comorbidities is needed for this population.
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Affiliation(s)
- Franklin Njoku
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Norma Pugh
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Donald Brambilla
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara Kroner
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Nirmish Shah
- Pediatric Hematology/Oncology, Duke University, Durham, North Carolina, USA
| | - Marsha Treadwell
- Department of Pediatrics/Division of Hematology, University of California San Francisco, Oakland, California, USA
| | - Robert Gibson
- Department of Emergency Medicine and Hospitalist Services, Augusta University, Augusta, Georgia
| | - Lewis L. Hsu
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jane S. Hankins
- Departments of Hematology and Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Abdullah Kutlar
- Sickle Cell Center, Augusta University, Augusta, Georgia, USA
| | - Allison A. King
- Division of Pediatric Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Julie Kanter
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
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5
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Prussien KV, Crosby LE, Faust HL, Barakat LP, Deatrick JA, Smith-Whitley K, Schwartz LA. An Updated Equitable Model of Readiness for Transition to Adult Care: Content Validation in Young People With Sickle Cell Disease. JAMA Pediatr 2024; 178:274-282. [PMID: 38190311 PMCID: PMC10775077 DOI: 10.1001/jamapediatrics.2023.5914] [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: 05/02/2023] [Accepted: 08/30/2023] [Indexed: 01/10/2024]
Abstract
Importance Despite elevated health risks during young adulthood, many adolescents and young adults with serious health care needs face barriers during the transfer to an adult specialty practitioner, and health disparities may occur during the transition. Objective To validate the content of an updated Social-Ecological Model of Adolescent and Young Adult Readiness for Transition to Promote Health Equity (SMART-E) in a group of adolescents and young adults with sickle cell disease (SCD) and their supports. Design, Setting, and Participants Health equity framework components were reviewed. Systems of power (eg, institutional and practitioner bias) and environments or networks (eg, peer or school support) were added as SMART-E preexisting factors, and health literacy was included within readiness factors. Adolescents and young adults aged 16 to 29 years with SCD, caregivers, and practitioners participated in this convergent, mixed-methods study within Children's Hospital of Philadelphia between January and August 2022. Main Outcomes and Measures Content validity was assessed through nominations of top 3 most important transition barriers prior to interviews and focus groups, ratings on importance of SMART-E factors (0-4 scale; ratings >2 support validity) after interviews and focus groups, nominations of 3 most important factors for transition and for health equity, and qualitative content analysis of interview transcripts. Results The study enrolled 10 pediatric adolescents and young adults (mean [SD] age, 18.6 [2.9] years; 4 female and 6 male), 10 transferred adolescents and young adults (mean [SD] age, 22.9 [2.1] years; 8 female and 2 male), 9 caregivers (mean [SD] age, 49.8 [8.7] years; 5 female and 4 male), and 9 practitioners (mean [SD] age, 45.6 [10.5] years; 8 female and 1 male). Quantitative ratings supported the content validity of SMART-E and met established criteria for validity. Systems of power was the most endorsed transition barrier (14 of 38 participants) reported prior to interviews and focus groups. After the interview, participants endorsed all SMART-E factors as important for transition, with new factors systems of power and environments and networks rated at a mean (SD) 2.8 (1.23) and 3.1 (0.90), respectively, on a 0 to 4 scale of importance. The most important factors for transition and equity varied by participant group, with all factors being endorsed, supporting the comprehensiveness of SMART-E. Qualitative data corroborated quantitative findings, further supporting validity, and minor modifications were made to definitions. Conclusions and Relevance SMART-E obtained initial content validation with inclusion of health equity factors for adolescents and young adults with SCD, caregivers, and practitioners. The model should be evaluated in other populations of adolescents and young adults with chronic disease.
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Affiliation(s)
- Kemar V. Prussien
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori E. Crosby
- Division of Behavioral Medicine, Cincinnati Children’s Hospital and Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Haley L. Faust
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lamia P. Barakat
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia
| | - Janet A. Deatrick
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia
| | - Kim Smith-Whitley
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Pfizer, New York, New York
| | - Lisa A. Schwartz
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia
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6
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Bangudi S, Stanek C, Shankar D, Hart L, Nahata L, Cronin RM, Creary SE. Primary care use and depression screening among young adults with sickle cell disease during their final year of pediatric hematology care. Pediatr Blood Cancer 2024; 71:e30784. [PMID: 38037196 DOI: 10.1002/pbc.30784] [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: 08/07/2023] [Revised: 10/25/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
Depression may contribute to transition risk among young adults with sickle cell disease (SCD). It is unclear if they receive depression screening because primary care providers (PCPs) routinely perform this screening, but PCP use declines with age. This retrospective study of young adults with SCD during their final year of pediatric hematology care identified 51 (91%) had PCPs. Among those with hospital system PCPs, 20% saw their PCP and 50% of those were screened for depression by the PCP. This suggests young adults with SCD may not receive depression screening or see PCPs, leading to potential missed opportunities for intervention.
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Affiliation(s)
- Suzy Bangudi
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Charis Stanek
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Divya Shankar
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Laura Hart
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leena Nahata
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Robert M Cronin
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Susan E Creary
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
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7
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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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8
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Howell KE, Heitzer AM, Longoria JN, Potter B, Wang WC, Anderson S, Kang G, Hankins JS, Porter JS. Assessment of transition readiness to predict health care utilization during transition to adult care in sickle cell disease. Expert Rev Hematol 2022; 15:1063-1072. [PMID: 36356169 PMCID: PMC9809157 DOI: 10.1080/17474086.2022.2144216] [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] [Received: 08/16/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Transition-age patients with sickle cell disease (SCD) are at risk for poor outcomes associated with incomplete transition readiness and neurocognitive deficits. Study objectives were to: 1) test if a SCD-specific measure of self-management skills was associated with transition outcomes and 2) evaluate if caregiver-reported executive functioning was associated with self-management skills and transition outcomes among youth with SCD. RESEARCH DESIGN AND METHODS Youth/caregivers were selected from a longitudinal cohort study. Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF); caregivers and youth completed the Self-Management Skills Checklist (SMSC) at a median age of 16.8 ± 0.6 years. Non-parametric tests compared SMSC and transition outcomes. Regression assessed the incremental validity of SMSC in predicting transition outcomes. RESULTS In total, 95 participants (54% male, 55% severe genotype) completed the SMSC assessment. Most participants (87%) transferred to adult care within six months and 87% were retained for at least 12 months. BRIEF and caregiver-reported SMSC assessments were weakly, negatively correlated (ρ = -0.25, p = 0.0392) but were not significant in predicting transition outcomes (p > 0.05). CONCLUSIONS The SMSC and executive function did not predict adult care engagement. Development of readiness assessments that predict care engagement and reflect self-efficacy is important for monitoring transition-aged patients with SCD.
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Affiliation(s)
| | | | | | - Brian Potter
- Department of Psychology, St. Jude Children’s Research Hospital
| | - Winfred C. Wang
- Department of Hematology, St. Jude Children’s Research Hospital
| | - Sheila Anderson
- Department of Hematology, St. Jude Children’s Research Hospital
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital
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9
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Sisler I, McClish DK, Valrie C, Villella A, Smith WR. Satisfaction and access to care for adults and adolescents with sickle cell disease: ASCQ-Me quality of care and the SHIP-HU study. Pediatr Blood Cancer 2022; 69:e29948. [PMID: 36151945 DOI: 10.1002/pbc.29948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/20/2022] [Accepted: 08/06/2022] [Indexed: 11/09/2022]
Abstract
A lack of adult sickle cell providers has long been blamed for poor satisfaction and access to specialty care for adults with sickle cell disease (SCD). We were interested in comparing how adolescent and adult patients already in established SCD centers perceived access and quality of care. Hydroxyurea-eligible patients aged 15 years and older were enrolled in the Start Healing in Patients with Hydroxyurea trial, which required them to be affiliated with a SCD specialist. Patients were seen in one of three adult-oriented specialty clinic sites or one of three pediatric-oriented sites. At baseline, patients completed the Adult Sickle Cell Quality of Life Measurement Information System measure as part of a survey battery. Patients treated at adult clinic sites reported being less able to get timely ambulatory appointments (p = .004). They reported emergency department (ED) wait times of >1 h far more often (47.7 vs. 19.3%, p = .0048). They reported less overall satisfaction with care (7.47 vs. 8.77, p < .0001), and less satisfaction with care in the ED (2.88 vs. 3.4, p = .0068. Ambulatory satisfaction was no different between pediatric site versus adult site patients. Poorer systems of care appeared to underlie reported differences, rather than differences in biopsychosocial determinants. Even among specialty-care-affiliated SCD patients, those seen in adult clinics reported worse access to care and lower satisfaction with care than patients seen in pediatric clinics. In addition to increasing the number of adult SCD providers and better preparing pediatric SCD patients to transfer to adult programs, SCD clinical caregivers must also improve aspects of adult care quality to meet reasonable patient expectations of timeliness and interpersonal aspects of care quality.
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Affiliation(s)
- India Sisler
- Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Donna K McClish
- Department of Statistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cecelia Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anthony Villella
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Wally R Smith
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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10
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Lamont AE, Hsu LL, Jacobs S, Gibson R, Treadwell M, Chen Y, Lottenberg R, Axelrod K, Varughese T, Melvin C, Smith S, Chukwudozie IB, Kanter J. What does it mean to be affiliated with care?: Delphi consensus on the definition of "unaffiliation" and "specialist" in sickle cell disease. PLoS One 2022; 17:e0272204. [PMID: 36367870 PMCID: PMC9651581 DOI: 10.1371/journal.pone.0272204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Accruing evidence reveals best practices for how to help individuals living with Sickle Cell Disease (SCD); yet, the implementation of these evidence-based practices in healthcare settings is lacking. The Sickle Cell Disease Implementation Consortium (SCDIC) is a national consortium that uses implementation science to identify and address barriers to care in SCD. The SCDIC seeks to understand how and why patients become unaffiliated from care and determine strategies to identify and connect patients to care. A challenge, however, is the lack of agreed-upon definition for what it means to be unaffiliated and what it means to be a "SCD expert provider". In this study, we conducted a Delphi process to obtain expert consensus on what it means to be an "unaffiliated patient" with SCD and to define an "SCD specialist," as no standard definition is available. Twenty-eight SCD experts participated in three rounds of questions. Consensus was defined as 80% or more of respondents agreeing. Experts reached consensus that an individual with SCD who is unaffiliated from care is "someone who has not been seen by a sickle cell specialist in at least a year." A sickle cell specialist was defined as someone with knowledge and experience in SCD. Having "knowledge" means: being knowledgeable of the 2014 NIH Guidelines, "Evidence-Based Management of SCD", trained in hydroxyurea management and transfusions, trained on screening for organ damage in SCD, trained in pain management and on SCD emergencies, and is aware of psychosocial and cognitive issues in SCD. Experiences that are expected of a SCD specialist include experience working with SCD patients, mentored by a SCD specialist, regular attendance at SCD conferences, and obtains continuing medical education on SCD every 2 years." The results have strong implications for future research, practice, and policy related to SCD by helping to lay a foundation for an new area of research (e.g., to identify subpopulations of unaffiliation and targeted interventions) and policies that support reaffiliation and increase accessibility to quality care.
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Affiliation(s)
| | - Lewis L. Hsu
- University of Illinois, Chicago, Illinois, United States of America
| | - Sara Jacobs
- RTI International, Research Triangle Park, NC, United States of America
| | - Robert Gibson
- Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Marsha Treadwell
- UCSF School of Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Yumei Chen
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | | | - Kathleen Axelrod
- RTI International, Research Triangle Park, NC, United States of America
| | - Taniya Varughese
- Washington University St Louis, St. Louis MO, United States of America
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Sharon Smith
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, United States of America
| | | | - Julie Kanter
- University of Alabama, Birmingham, Birmingham, AL, United States of America
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11
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Fergus KB, Zambeli-Ljepović A, Hampson LA, Copp HL, Nagata JM. Health care utilization in young adults with childhood physical disabilities: a nationally representative prospective cohort study. BMC Pediatr 2022; 22:505. [PMID: 36008822 PMCID: PMC9413894 DOI: 10.1186/s12887-022-03563-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Young people with physical disabilities face barriers to accessing health care; however, few studies have followed adolescents with physical disabilities longitudinally through the transition of care into adulthood. The objective of this study was to investigate differences in health care utilization between adolescents with physical disabilities and those without during the transition period from adolescent to adult care. METHODS We utilized the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study following adolescents ages 11-18 at baseline (1994-1995) through adulthood. Baseline physical disability status was defined as difficulty using limbs, using assistive devices or braces, or having an artificial limb; controls met none of these criteria. Health care utilization outcomes were measured seven years after baseline (ages 18-26). These included yearly physical check-ups, unmet health care needs, and utilization of last-resort medical care, such as emergency departments, inpatient hospital wards, and inpatient mental health facilities. Multiple logistic regression models were used to predict health care utilization, controlling for age, sex, race/ethnicity, insurance status, and history of depression. RESULTS Thirteen thousand four hundred thirty-six participants met inclusion criteria, including 4.2% with a physical disability and 95.8% without. Half (50%) of the sample were women, and the average age at baseline was 15.9 years (SE = 0.12). In logistic regression models, those with a disability had higher odds of unmet health care needs in the past year (Odds Ratio (OR) 1.41 95% CI 1.07-1.87), two or more emergency department visits in the past five years (OR 1.34 95% CI 1.06-1.70), and any hospitalizations in the past five years (OR 1.36 95% CI 1.07-1.72). No statistically significant differences in preventive yearly check-ups or admission to mental health facilities were noted. CONCLUSIONS Young adults with physical disabilities are at higher risk of having unmet health care needs and using last-resort health care services compared to their non-disabled peers.
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Affiliation(s)
- Kirkpatrick B Fergus
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Alan Zambeli-Ljepović
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Lindsay A Hampson
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Hillary L Copp
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California-San Francisco, 550 16th Street, 4th Floor, Box 0530, San Francisco, CA, 94143, USA.
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12
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Dawson A, Mullen K, Janson IA, Henriksen B, Duncan N, O'Brien D, Meier ER. A Feasibility Pilot Study of Online Modules of Hydroxyurea and Sickle Cell Disease Care for Adolescents and Young Adults for Family Medicine Residents. J Pediatr Hematol Oncol 2022; 44:e313-e318. [PMID: 34054051 DOI: 10.1097/mph.0000000000002224] [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: 01/15/2021] [Accepted: 04/30/2021] [Indexed: 01/19/2023]
Abstract
Family medicine (FP) residency programs are located throughout Indiana, and most adults with sickle cell disease (SCD) in Indiana have access to a primary care clinic administered by a FP program. Allen County ranks third in SCD incidence in Indiana, but has few providers for adolescents, young adults (AYAs) and adults with SCD. Initiation of a novel partnership between Indianapolis-based adult hematologists (130 miles distant), and the FP program in Allen County aimed to educate FP residents about SCD, hydroxyurea, transition, and SCD complications. To determine the feasibility of utilizing online learning modules to educate FP residents about SCD care in AYA and adults, 3 online learning modules (comprehensive care of AYAs with SCD, hydroxyurea, and best practices in AYA transition) were developed and continuing medical education-accredited. Electronic pretest and posttest were distributed to 32 FP residents to test the retention of content through an Institutional Review Board approved protocol. This pilot study demonstrates that it is feasible to utilize online educational modules to educate providers about SCD care.
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Affiliation(s)
| | | | - Isaac A Janson
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
| | | | - Natalie Duncan
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
| | - Dennis O'Brien
- Pediatric Hematology/Oncology, Lutheran Children's Hospital, Fort Wayne
| | - Emily R Meier
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
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13
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Fasipe T, Dongarwar D, Lopez E, Brown R, Abadom M, Mahoney DH, Salihu HM. Hospital Use and Mortality in Transition-Aged Patients With Sickle Cell Disease. Hosp Pediatr 2021; 11:hpeds.2021-005806. [PMID: 34808666 DOI: 10.1542/hpeds.2021-005806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Childhood mortality in sickle cell disease (SCD) has decreased, but the transition period is associated with poor outcomes and higher mortality rates. We analyzed recent US hospitalizations and mortality trends in the transition-aged population and evaluated for differences between patients with and without SCD. METHODS Nationwide Inpatient Sample database was used to analyze hospitalizations among individuals aged 16 to 24 years from 2003 to 2017. Diagnoses were coded by using International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, 10th Revision, Clinical Modification. We performed bivariate analyses to assess associations between sociodemographic characteristics and SCD hospitalizations, joinpoint regression analysis to describe mortality rate trends in SCD hospitalizations, and adjusted survey logistic regression to assess associations between patient characteristics and in-hospital mortality among transition-aged SCD and non-SCD-related hospitalizations. RESULTS There were 37 344 532 hospital encounters of patients aged 16 to 24 years during 2003-2017; both SCD and non-SCD hospitalizations increased with age. Female patients accounted for 78% of non-SCD and 54.9% of SCD hospitalizations. Although there was a +3.2% average annual percent change in SCD hospitalizations, total SCD in-hospital mortality rates did not have a statistically significant increase in average annual percent change over the study period. Patients with SCD aged 19 to 21 and 22 to 24 were more likely to suffer in-hospital mortality than those aged 16 to 18 (odds ratio = 2.09 and 2.71, respectively); the increased odds in mortality by age were not seen in our non-SCD population. CONCLUSIONS Transition-aged hospitalizations increase with age, but SCD hospitalizations have disparate age-related mortality rates. Hospital-based comprehensive care models are vital to address the persistent burden of early adulthood mortality in SCD.
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Affiliation(s)
- Titilope Fasipe
- Section Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Cancer & Hematology Centers, Houston, Texas
- Center of Excellence in Health Equity, Training and Research
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training and Research
| | - Elyse Lopez
- Center of Excellence in Health Equity, Training and Research
| | - Ria Brown
- Center of Excellence in Health Equity, Training and Research
| | - Megan Abadom
- Center of Excellence in Health Equity, Training and Research
| | - Donald H Mahoney
- Section Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Cancer & Hematology Centers, Houston, Texas
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training and Research
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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14
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Smith WR, McClish DK, Lottenberg R, Sisler IY, Sop D, Johnson S, Villella A, Liles D, Yang E, Chen I. A randomised controlled provider-blinded trial of community health workers in sickle cell anaemia: effects on haematologic variables and hydroxyurea adherence. Br J Haematol 2021; 196:193-203. [PMID: 34786695 DOI: 10.1111/bjh.17952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/13/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022]
Abstract
Hydroxyurea (hydroxycarbamide) (HU) for sickle cell anaemia (SCA) is underutilised. Case management is an evidence-based health management strategy and in this regard patient navigators (PNs) may provide case management for SCA. We hypothesised that HU-eligible patients exposed to PNs would have improved indicators of starting HU and HU adherence. We randomised 224 HU-eligible SCA adults into the Start Healing in Patients with Hydroxyurea (SHIP-HU) Trial. All patients received care from trained physicians using standardised HU prescribing protocols. Patients in the Experimental arm received case management and education from PNs through multiple contacts. All other patients were regarded as the Control arm and received specialty care alone. Study physicians were blinded to the study arms and did not interact with PNs. At baseline, 6 and 12 months we assessed and compared laboratory parameters and HU adherence indicators. Experimental patients had higher 6-month mean fetal haemoglobin (HbF) levels than controls. But at 12 months, mean HbF was similar, as were white blood cell count, absolute neutrophil count, total haemoglobin, platelet count and mean corpuscular volume. At 12 months there were fewer experimental patients missing HU doses than controls (mean 1·8 vs. 4·5, P = 0·0098), and more recent HU prescriptions filled than for controls (mean 53·8 vs. 92 days, median 27·5 vs. 62 days, P = 0·0082). Mean HU doses were largely similar. We detected behavioural improvements in HU adherence but no haematological improvements by adding PNs to specialty care.
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Affiliation(s)
- Wally R Smith
- Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard Lottenberg
- Division of Haematology/Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - India Y Sisler
- Department of Pediatrics, Division of Pediatric Haematology and Oncology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Daniel Sop
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Shirley Johnson
- Adult Sickle Cell Program, Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Anthony Villella
- Department of Pediatrics, Haematology & Oncology, Columbus, OH, USA
| | - Darla Liles
- Department of Internal Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Elizabeth Yang
- Pediatric Specialists of Virginia, 6565 Arlington Boulevard, Falls Church, VA, USA
| | - Ian Chen
- Eastern Virginia Medical School, Medical Service, Hampton VA Medical Center, Hampton, VA, USA
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15
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Rea KE, Cushman GK, Santee T, Mee L. Biopsychosocial factors related to transition among adolescents and young adults with sickle cell disease: A systematic review. Crit Rev Oncol Hematol 2021; 167:103498. [PMID: 34656745 DOI: 10.1016/j.critrevonc.2021.103498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/02/2021] [Accepted: 10/10/2021] [Indexed: 01/19/2023] Open
Abstract
It is critical to support adolescents and young adults (AYAs) with sickle cell disease (SCD) during transition to adult healthcare. We provide a systematic review of literature related to biopsychosocial influences on transition among AYAs with SCD. Data sources included studies published between January 2010 and May 2020. Forty-four studies were included. Biopsychosocial factors related to improved transition outcomes included older AYA age, greater disease severity, intact neurocognitive functioning, and greater pain coping skills. Financial and insurance barriers were noted. The importance of cultural considerations and provider communication were noted across two qualitative studies. Ten studies assessed efficacy of transition interventions, with 80 % resulting in improvements; however, retention in programs was low and gaps in knowledge and skills remained. Incorporation of early, ongoing assessments of transition readiness and barriers into culturally-tailored interventions aimed at improving transition outcomes is recommended. Examination of longitudinal relationships and interactions across biopsychosocial influences is needed.
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Affiliation(s)
- Kelly E Rea
- University of Georgia, Department of Psychology, United States.
| | - Grace K Cushman
- University of Georgia, Department of Psychology, United States
| | - Tara Santee
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States
| | - Laura Mee
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States; Emory University School of Medicine, Department of Pediatrics, United States
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16
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Time to First Completed Visit and Health Care Utilization Among Young Adults Transferring From Pediatric to Adult Rheumatologic Care in a Safety‐Net Hospital. Arthritis Care Res (Hoboken) 2021; 73:1730-1738. [DOI: 10.1002/acr.24409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
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17
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Perry Caldwell E, Killingsworth E. The health literacy disparity in adolescents with sickle cell disease. J SPEC PEDIATR NURS 2021; 26:e12353. [PMID: 34327799 DOI: 10.1111/jspn.12353] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There are over 100,000 individuals with sickle cell disease (SCD) in the United States, most of whom are Black, poor, and publically insured. In combination with a chronic illness, these demographics lead to significant barriers to healthcare for patients with SCD, leaving them exceptionally vulnerable within the healthcare system. This unique vulnerability is especially notable when transitioning adolescents with SCD from pediatric to adult care, as this is a significant time of morbidity and mortality for these patients. It is postulated that health literacy influences transition from pediatric to adult care in adolescents with SCD. To better understand this relationship, more adolescent health literacy research must be conducted with both adolescents with and without SCD. Therefore, the purpose of this study is to systematically compare health literacy in adolescents with and without SCD. DESIGN AND METHODS This is a cross-sectional, descriptive, exploratory study. One hundred and thirty-four adolescents with SCD and 105 adolescents without SCD were recruited for this study. The Newest Vital Sign (NVS) health literacy instrument was used to evaluate health literacy. Pearson correlations were conducted to evaluate relationships among health literacy and the influencing factors of age, grade level, income, and parental education level. Differences in NVS scores between groups were assessed using independent samples t tests. RESULTS There was a significant relationship between health literacy, age (r = .286, p < .01) and grade level (r = .317, p = .00) in adolescents with SCD. In adolescents without SCD, there was a significant relationship between health literacy, income (r = .235; p < .05) and parental education (r = .263; p < .01). The mean NVS score was 2.66 for adolescents with SCD and 3.77 for adolescents without SCD. A statistically significant difference in NVS scores was found between groups (t = 4.772; p < .001). Adolescents with SCD demonstrated significantly lower NVS scores than adolescents without SCD. PRACTICE IMPLICATIONS There are significant differences in health literacy scores and influencing factors in adolescents with and without SCD. Thus, this article provides unique insight for nurses as they design, implement and evaluate health promotion, patient education, and future research initiatives for adolescents and families, both with and without SCD. Further research is needed to gain more insight into this phenomenon.
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Affiliation(s)
| | - Erin Killingsworth
- Louise Herrington School of Nursing, Baylor University, Dallas, Texas, USA
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18
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Rettenbacher E, Zaal J, Heijboer H, van der Plas EM, Hof M, Biemond BJ, Fijnvandraat K. Mortality and Causes of Death From Sickle Cell Disease in The Netherlands, 1985-2017. J Pediatr Hematol Oncol 2021; 43:258-265. [PMID: 34001787 DOI: 10.1097/mph.0000000000002193] [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: 07/17/2020] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
In the Netherlands, between 1985 and 2007 secular changes in the health care of patients with sickle cell disease (SCD) have taken place, such as penicillin prophylaxis, vaccination programs and stroke prevention. We investigated the number and causes of death in a cohort of 298 SCD patients, established in 2007, before introduction of neonatal screening, to determine preventable deaths. All patients were diagnosed with SCD before the age of 18 (median age at diagnosis 5.1 y). Their vital status was determined up to January 2017. After a total follow-up period of 4565 patient years and a median time of follow-up of 15 years for all patients, 230 patients (77%) were still alive, 45 patients (15%) were lost to follow-up and a total of 23 patients (8%) had died. Estimated survival to 18 years was 92% with a global mortality rate of 0.48 deaths/100 patient years. Leading causes of death were infection (35%) followed by neurologic complications (22%) and death in the course of a painful episode (13%). Nine of the 20 known causes of death were preventable. These results strongly suggest the benefit of comprehensive care measures for patients with SCD in the Netherlands to further prevent morbidity and mortality.
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Affiliation(s)
- Eva Rettenbacher
- Department of Pediatric Hematology, Amalia Children's Hospital, Radboudumc, University Medical Center, Nijmegen
| | | | | | | | - Michel Hof
- Departments of Clinical Epidemiology, Biostatistics and Bioinformatics
| | - Bart J Biemond
- Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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19
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Jones KE, Nyman TN, Daly BP, Jacobson LA, Tarazi RA. Executive Functioning Predicts Adaptive Functioning and Self-Care Independence in Pediatric Sickle Cell Disease. J Pediatr Psychol 2021; 47:206-214. [PMID: 34524455 DOI: 10.1093/jpepsy/jsab094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study examined the impact of executive functioning (EF) on adaptive functioning and self-care independence in pre-transition youth with sickle cell disease (SCD). METHODS Thirty-four youth with SCD (ages 12-18 years) completed a brief neuropsychological battery and their caregivers completed questionnaires assessing adaptive functioning, EF behaviors, and independence in completing self-care tasks, including disease management. Hierarchical linear regression analyses were utilized to investigate if EF predicted significantly more variability in adaptive functioning and self-care independence than what is accounted for by socioeconomic status (SES), disease knowledge, and estimated intellectual functioning. RESULTS Mean performance on standardized measures assessing working memory, processing speed, and EF skills fell in the low average range. Performance-based EF and caregiver-reported EF behaviors predicted variance in adaptive functioning and self-care independence above and beyond that accounted for by SES, disease knowledge, and intelligence, with moderate to large effect sizes. CONCLUSIONS EF skills may support the ability of youth with SCD to adequately achieve independence in self-care, including medical self-care, and other adaptive skills, which may increase the likelihood of successful transition to young adulthood. These findings provide support for the role of neuropsychological screening and individualized intervention in interdisciplinary transition programs.
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Affiliation(s)
| | | | | | - Lisa A Jacobson
- Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Reem A Tarazi
- Division of Hematology, St. Christopher's Hospital for Children, Philadelphia, PA, USA.,Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA, USA
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20
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Viola A, Porter J, Shipman J, Brooks E, Valrie C. A scoping review of transition interventions for young adults with sickle cell disease. Pediatr Blood Cancer 2021; 68:e29135. [PMID: 34089222 PMCID: PMC8316342 DOI: 10.1002/pbc.29135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/18/2021] [Accepted: 05/08/2021] [Indexed: 11/06/2022]
Abstract
Standardized programming for individuals with sickle cell disease (SCD) transitioning from pediatric to adult-centered care does not currently exist, resulting in high rates of mortality and morbidity. This scoping review examines and evaluates the current literature on SCD transition programs and interventions. Eligible studies described an existing program for individuals with SCD aged 12-29 years preparing to transition. The Evidence Project risk-of-bias tool was used to assess article quality. We identified 30 eligible articles, of which, only two were randomized controlled trials. Many studies have incomplete reports of feasibility information, such as completion rates, patient characteristics, and attrition; all studies were limited to a single institution; and most studies were rated high for risk of bias. Progress has been made in designing and gathering initial evaluation data for SCD transition programs; however, there is a need for higher quality studies, consistent assessment, and better dissemination of programs.
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Affiliation(s)
- Adrienne Viola
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jerlym Porter
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Ellen Brooks
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Cecilia Valrie
- Virginia Commonwealth University, Richmond, Virginia, USA
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21
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Champlin G, Hwang SN, Heitzer A, Ding J, Jacola L, Estepp JH, Wang W, Ataga KI, Owens CL, Newman J, King AA, Davis R, Kang G, Hankins JS. Progression of central nervous system disease from pediatric to young adulthood in sickle cell anemia. Exp Biol Med (Maywood) 2021; 246:2473-2479. [PMID: 34407676 DOI: 10.1177/15353702211035778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Silent cerebral infarcts and arteriopathy are common and progressive in individuals with sickle cell anemia. However, most data describing brain lesions in sickle cell anemia are cross-sectional or derive from pediatric cohorts with short follow-up. We investigated the progression of silent cerebral infarct and cerebral vessel stenosis on brain MRI and MRA, respectively, by describing the incidence of new or worsening lesions over a period of up to 25 years among young adults with sickle cell anemia and explored risk factors for progression. Forty-four adults with sickle cell anemia (HbSS or HbSβ0thalassemia), exposed to chronic transfusions (n = 12) or hydroxyurea (n = 32), median age 19.2 years (range 18.0-31.5), received a screening brain MRI/MRA and their results were compared with a clinical exam performed during childhood and adolescence. We used exact log-rank test to compare MRI and MRA progression among any two groups. The hazard ratio (HR) and 95% confidence interval (CI) were calculated from Cox regression analyses. Progression of MRI and MRA occurred in 12 (27%) and 4 (9%) young adults, respectively, relative to their pediatric exams. MRI progression risk was high among participants with abnormal pediatric exams (HR: 11.6, 95% CI: 2.5-54.7) and conditional or abnormal transcranial Doppler ultrasound velocities (HR: 3.9, 95% CI: 1.0-15.1). Among individuals treated with hydroxyurea, high fetal hemoglobin measured in childhood was associated with lower hazard of MRI progression (HR: 0.86, 95% CI: 0.76-0.98). MRA progression occurred more frequently among those with prior stroke (HR: 8.6, 95% CI: 1.2-64), abnormal pediatric exam (P = 0.00084), and elevated transcranial Doppler ultrasound velocities (P = 0.004). Brain MRI/MRA imaging in pediatrics can identify high-risk patients for CNS disease progression in young adulthood, prompting consideration for early aggressive treatments.
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Affiliation(s)
- Grace Champlin
- Department of Clinical Education and Training, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Scott N Hwang
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Andrew Heitzer
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Juan Ding
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Lisa Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jeremie H Estepp
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.,Global Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Winfred Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kenneth I Ataga
- University of Tennessee Health Science Center (UTHSC), Center for Sickle Cell Disease, Memphis, TN 38163, USA.,Methodist University Comprehensive Sickle Cell Center, Memphis, TN 38104, USA
| | - Curtis L Owens
- Methodist University Comprehensive Sickle Cell Center, Memphis, TN 38104, USA
| | - Justin Newman
- Memphis Radiological Professional Corporation, Memphis, TN 38138, USA
| | - Allison A King
- Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Robert Davis
- Center in Biomedical Informatics at UTHSC, Memphis, TN 38163, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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22
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Caldwell EP, Rosonet LE. The Influence of Health-Seeking Behaviors on the Health Literacy of Adolescents With Sickle Cell Disease. J Pediatr Oncol Nurs 2021; 38:307-312. [PMID: 33960864 DOI: 10.1177/10434542211011045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Health literacy may influence the transition from pediatric care to adult care in adolescents with sickle cell disease (SCD). It is postulated that one influencing factor of health literacy in adolescents with SCD is health-seeking behavior. The purpose of this study was twofold: (1) to explore health-seeking behaviors of adolescents with SCD and (2) to determine if there are significant differences in health literacy levels of adolescents with SCD based upon health-seeking behaviors. Methods: This was a cross-sectional, descriptive study evaluating health-seeking behaviors and health literacy in 110 Black and non-Hispanic adolescents with SCD. Convenience sampling was utilized for recruitment. The inclusion criteria were a diagnosis of one of the four primary genotypes of SCD and age of 10-19 years. Health literacy was evaluated using the Newest Vital Sign (NVS). Frequencies and percentages were calculated for all variables. Independent Samples t-tests were conducted to evaluate differences in health literacy scores based upon differing health-seeking behaviors. Results: The mean age of participants was 14.8 years (SD = 2.2). The mean NVS score was 2.7 (SD = 1.6). The two most common responses to "where do you go FIRST for health information?" were the Internet (29.6%; n = 40) and health care providers (27.4%; n = 37). There was no statistical difference in NVS scores between adolescents using the Internet versus health care providers as their first source of health information (t[75] = - .12; p = .22). Discussion: Knowledge of health-seeking behaviors and health literacy in adolescents with SCD gives insight into the design and evaluation of future interventions to improve health and health literacy in this population.
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Affiliation(s)
| | - Libby E Rosonet
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
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Saulsberry-Abate AC, Partanen M, Porter JS, Podila PSB, Hodges JR, King AA, Wang WC, Schreiber JE, Zhao X, Kang G, Jacola LM, Hankins JS. Cognitive performance as a predictor of healthcare transition in sickle cell disease. Br J Haematol 2021; 192:1082-1091. [PMID: 33570182 DOI: 10.1111/bjh.17351] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022]
Abstract
Neurocognitive deficits in sickle cell disease (SCD) may impair adult care engagement. We investigated the relationship between neurocognitive functioning and socio-environmental factors with healthcare transition outcomes. Adolescents aged 15-18 years who had neurocognitive testing and completed a visit with an adult provider were included. Transition outcomes included transfer interval from paediatric to adult care and retention in adult care at 12 and 24 months. Eighty adolescents (59% male, 64% HbSS/HbSβ0 -thalassaemia) were included. Mean age at adult care transfer was 18·0 (±0·3) years and transfer interval was 2·0 (±2·3) months. Higher IQ (P = 0·02; PFDR = 0·05) and higher verbal comprehension (P = 0·008; PFDR = 0·024) were associated with <2 and <6 month transfer intervals respectively. Better performance on measures of attention was associated with higher adult care retention at 12 and 24 months (P = 0·009; PFDR = 0·05 and P = 0·04; PFDR = 0·12 respectively). Transfer intervals <6 months were associated with smaller households (P = 0·02; PFDR = 0·06) and households with fewer children (P = 0·02; PFDR = 0·06). Having a working parent was associated with less retention in adult care at 12 and 24 months (P = 0·01; P = 0·02 respectively). Lower IQ, verbal comprehension, attention difficulties and environmental factors may negatively impact transition outcomes. Neurocognitive function should be considered in transition planning for youth with SCD.
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Affiliation(s)
| | - Marita Partanen
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan, The Netherlands
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pradeep S B Podila
- Methodist Comprehensive Sickle Cell Center, Methodist University Hospital, Memphis, TN, USA
| | - Jason R Hodges
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Allison A King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO, USA
| | - Winfred C Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane E Schreiber
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiwen Zhao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
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24
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Schnitzler ER, Schneck MJ. Therapeutic Pitfalls in the Transition of Neurologic Patients from Pediatric to Adult Health Care Providers. Neurol Clin 2020; 39:243-256. [PMID: 33223087 DOI: 10.1016/j.ncl.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Transitions of care from the pediatric to adult setting are fraught with difficulty. For patients whose neurologic problems began in childhood, there is often a lack of organized multidisciplinary care with the desired neurologic expertise in the adult setting. This monograph highlights those difficulties, reviewing disease-specific instances of the problems with transition from pediatric to adult neurologic care. The use of an arbitrary chronologic age cutoff for transition from pediatric to adult expertise in specific disease state may be a disservice in provision of care, and the disease-specific expertise of providers may outweigh the benefit of an age-related provider focus.
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Affiliation(s)
- Eugene R Schnitzler
- Department of Neurology, Division of Pediatric Neurology, Loyola University Chicago, Stritch School of Medicine, Maguire Building Suite 2700, 2160 South First Avenue, Maywood, IL 60153, USA; Department of Pediatrics, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
| | - Michael J Schneck
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA; Department of Neurosurgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
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25
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Renedo A, Miles S, Chakravorty S, Leigh A, Warner JO, Marston C. Understanding the health-care experiences of people with sickle cell disorder transitioning from paediatric to adult services: This Sickle Cell Life, a longitudinal qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background
Transitions from paediatric to adult health-care services cause problems worldwide, particularly for young people with long-term conditions. Sickle cell disorder brings particular challenges needing urgent action.
Objectives
Understand health-care transitions of young people with sickle cell disorder and how these interact with broader transitions to adulthood to improve services and support.
Methods
We used a longitudinal design in two English cities. Data collection included 80 qualitative interviews with young people (aged 13–21 years) with sickle cell disorder. We conducted 27 one-off interviews and 53 repeat interviews (i.e. interviews conducted two or three times over 18 months) with 48 participants (30 females and 18 males). We additionally interviewed 10 sickle cell disease specialist health-care providers. We used an inductive approach to analysis and co-produced the study with patients and carers.
Results
Key challenges relate to young people’s voices being ignored. Participants reported that their knowledge of sickle cell disorder and their own needs are disregarded in hospital settings, in school and by peers. Outside specialist services, health-care staff refuse to recognise patient expertise, reducing patients’ say in decisions about their own care, particularly during unplanned care in accident and emergency departments and on general hospital wards. Participants told us that in transitioning to adult care they came to realise that sickle cell disorder is poorly understood by non-specialist health-care providers. As a result, participants said that they lack trust in staff’s ability to treat them correctly and that they try to avoid hospital. Participants reported that they try to manage painful episodes at home, knowing that this is risky. Participants described engaging in social silencing (i.e. reluctance to talk about and disclose their condition for fear that others will not listen or will not understand) outside hospital; for instance, they would avoid mentioning cell sickle disorder to explain fatigue. Their self-management tactics include internalising their illness experiences, for instance by concealing pain to protect others from worrying. Participants find that working to stay healthy is difficult to reconcile with developing identities to meet adult life goals. Participants have to engage in relentless self-disciplining when trying to achieve educational goals, yet working hard is incompatible with being a ‘good adult patient’ because it can be risky for health. Participants reported that they struggle to reconcile these conflicting demands.
Limitations
Our findings are derived from interviews with a group of young people in England and reflect what they told us (influenced by how they perceived us). We do not claim to represent all young people with sickle cell disorder.
Conclusions
Our findings reveal poor care for young people with sickle cell disorder outside specialist services. To improve this, it is vital to engage with young people as experts in their own condition, recognise the legitimacy of their voices and train non-specialist hospital staff in sickle cell disorder care. Young people must be supported both in and outside health-care settings to develop identities that can help them to achieve life goals.
Future work
Future work should include research into the understanding and perceptions of sickle cell disease among non-specialist health-care staff to inform future training. Whole-school interventions should be developed and evaluated to increase sickle cell disorder awareness.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 44. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alicia Renedo
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Miles
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Andrea Leigh
- University College London NHS Hospitals Foundation Trust, London, UK
| | - John O Warner
- National Heart and Lung Institute, Imperial College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care for Northwest London, Imperial College London, London, UK
| | - Cicely Marston
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Crosby LE, Hood A, Kidwell K, Nwankwo C, Strong H, Quinn C, Britto MT. Improving self-management in adolescents with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28492. [PMID: 32697889 PMCID: PMC7722105 DOI: 10.1002/pbc.28492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/29/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with significant medical challenges that often worsen in adolescence when caregivers are beginning to transfer responsibility for disease management. Behavioral activation (BA) is an important precedent to improvements in self-management and ultimately health outcomes; however, few interventions targeting BA have been developed for the SCD population. The goal of the present study was to evaluate a technology-enhanced self-management intervention for adolescents and young adults (AYA) with SCD targeting BA domains (ie, disease knowledge, self-efficacy, motivation, and self-management skills). DESIGN/METHODS Participants were randomized to one of two study arms. SCThrive participants (N = 26) completed six weekly group sessions, an in-person booster session, and used a companion app (iManage) to record symptoms, progress on goals, and connect with other group members. Each SCHealthEd participant (N = 27) received six weekly phone calls on SCD-related and general health education topics. All AYA completed questionnaires assessing BA at baseline and posttreatment. RESULTS Separate mixed ANOVA analyses to assess for the effects of group (SCThrive/SCHealthEd), time (baseline/posttreatment), and group × time interaction indicated that there was a clinically meaningful improvement (8-point change) in self-efficacy, with a medium effect size, P = .09, η2 = .06, and there was statistically significant improvement in one self-management skill (tracking health), P = .001, d = .71, among SCThrive participants. CONCLUSIONS The results support the potential for a self-management intervention to improve self-efficacy in AYA with SCD. Health care providers are encouraged to target BA skills to support self-management of AYA with SCD.
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Affiliation(s)
- Lori E. Crosby
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Anna Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Katherine Kidwell
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Cara Nwankwo
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Oklahoma State University, Department of Psychology, Stillwater, OK
| | - Heather Strong
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Charles Quinn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Maria T. Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Durkin LK, Neff Greenley R. JPP Student Journal Club Commentary: Review of Psychological Interventions Targeting Adherence Among Pediatric Sickle Cell Disease. J Pediatr Psychol 2020; 45:607-609. [PMID: 32529209 DOI: 10.1093/jpepsy/jsaa049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/14/2022] Open
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Gros M, Jung C, Fourmaux C, Kamdem A, Arnaud C, Hau I, Pondarre C, Carlier-Gonod A. Sexual health of French adolescents with sickle cell disease. EUR J CONTRACEP REPR 2020; 25:293-298. [PMID: 32496830 DOI: 10.1080/13625187.2020.1774868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Focussing on sickle cell disease (SCD), the objective of this study was to assess adolescents' sexual heath experience in the context of their chronic illness. MATERIALS AND METHODS We included teenagers from 14 to 19 years old followed for SCD in a hospital located in Créteil (France) from March 2017 to February 2018. Their sexual health experience was assessed by a self-questionnaire with three key themes: contraceptive experience, awareness of sexuality with chronic disease and level of information on the genetic transmission of the disease. RESULTS 99 questionnaires were analysed. Only six SCD adolescents (one girl and five boys) reported being sexually active. Despite a very regular follow-up of their illness, only 13% of the boys and girls had received information on contraception at the hospital. Most adolescents (85% of boys and 81% of girls) did not think that the disease would interfere with sexual intercourse. The genetic pattern was well known (85% of boys and 87% of girls). CONCLUSION Young people with SCD need more information on contraception. Clinicians caring for them should be aware of the need for sexual health information in order to propose prevention actions adapted to these young people with chronic disease.
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Affiliation(s)
- Marion Gros
- Pediatrics Department, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France.,Unité des Infections Bactériennes Invasives, Institut Pasteur, Paris, France
| | - Camille Jung
- Pediatrics Department, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | - Christine Fourmaux
- Pediatrics Department, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | - Annie Kamdem
- Pediatrics Department, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | - Cécile Arnaud
- Pediatrics Department, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | - Isabelle Hau
- Pediatrics Department, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | - Corinne Pondarre
- Pediatrics Department, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France.,INSERM Unité 955, Université Paris-Est Créteil, Créteil, France
| | - Adèle Carlier-Gonod
- Pediatrics Department, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
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29
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Kingsley RA. A Healthcare Improvement Initiative to Increase Multidisciplinary Pain Management Referrals for Youth with Sickle Cell Disease. Pain Manag Nurs 2020; 21:403-409. [PMID: 32448738 DOI: 10.1016/j.pmn.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/18/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic pain is a complex integration of biological, psychological, and social variables. Multidisciplinary pain management experts design interventions that treat the multidimensional experience. Children and adolescents with sickle cell disease (SCD) are at risk for chronic pain. Increased risk is associated with multiple characteristics including sickle cell genotype, age, gender, frequency of hospitalization, duration of hospitalization, and certain comorbid diagnoses. Referral to pain management professionals for this population is often delayed. AIMS To increase multidisciplinary pain management referrals for youth with SCD identified to be at risk for chronic pain. DESIGN Implementation research. SETTING One pediatric, academic medical facility serving as a regional sickle cell treatment center in the Midwest. PARTICIPANTS Children greater than 2 years of age and less than 21 years of age with laboratory confirmed SCD. METHODS Implementation of an evidence-based screening tool using the consolidated framework for implementation research (CFIR) to guide project planning, design, and evaluation. The CFIR model was paired with the Plan-Do-Study-Act (PDSA) quality improvement methodology to operationalize workflow and sustain project aims. RESULTS AND CONCLUSIONS Eighty-four percent of all eligible patients were screened during their routine sickle cell appointments resulting in a 110% increase in multidisciplinary pain management referrals. Future interventions and PDSA cycles are targeted at improving attendance at scheduled appointments, reducing hospitalizations, decreasing 30-day readmissions, and shortening length of stay.
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Affiliation(s)
- Rae Ann Kingsley
- Children's Mercy Hospital, Integrative Pain Management Clinic, Kansas City, Missouri
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30
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Inusa BPD, Stewart CE, Mathurin-Charles S, Porter J, Hsu LLY, Atoyebi W, De Montalembert M, Diaku-Akinwumi I, Akinola NO, Andemariam B, Abboud MR, Treadwell M. Paediatric to adult transition care for patients with sickle cell disease: a global perspective. LANCET HAEMATOLOGY 2020; 7:e329-e341. [PMID: 32220342 DOI: 10.1016/s2352-3026(20)30036-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 01/19/2023]
Abstract
Sickle cell disease is a life-threatening inherited condition designated as a public health priority by WHO. Increased longevity of patients with sickle cell disease in high-income, middle-income, and low-income countries present unprecedented challenges for all settings; however, a globally standardised solution for patient transition from paediatric to adult sickle cell disease health care is unlikely to address the challenges. We established a task force of experts from a multicountry (the USA, Europe, Middle East, and Africa) consortium. We combined themes from the literature with viewpoints from members of the task force and invited experts to provide a global overview of transition care practice, highlighting barriers to effective transition care and provide baseline recommendations that can be adapted to local needs. We highlighted priorities to consider for any young person with sickle cell disease transitioning from paediatric to adult health care: skills transfer, increasing self-efficacy, coordination, knowledge transfer, linking to adult services, and evaluating readiness (the SICKLE recommendations). These recommendations aim to ensure appropriate benchmarking of transition programming, but multisite prospective studies are needed to address this growing public health need.
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Affiliation(s)
- Baba Psalm Duniya Inusa
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, UK.
| | | | | | - Jerlym Porter
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lewis Li-Yen Hsu
- Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Wale Atoyebi
- Cancer and Haematology Centre, Churchill Hospital, Oxford, UK
| | - Mariane De Montalembert
- Reference Center for Sickle Cell Disease, Hôpital Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris France; Labex GR-Ex, Paris, France
| | | | - Norah O Akinola
- Department of Haematology and Immunology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Biree Andemariam
- New England Sickle Cell Institute, Neag Comprehensive Cancer Center, University of Connecticut Health, Farmington, CT, USA
| | - Miguel Raul Abboud
- Department of Pediatric Hematology Oncology, American University Beirut, American University Beirut, Lebanon
| | - Marsha Treadwell
- University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
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Caldwell EP. Health literacy in adolescents with sickle cell disease: The influence of caregiver health literacy. J SPEC PEDIATR NURS 2020; 25:e12284. [PMID: 31825171 DOI: 10.1111/jspn.12284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/27/2019] [Accepted: 11/19/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE After patients with sickle cell disease (SCD) transfer from pediatric care to adult care, significant morbidity and mortality occurs. There are many possible contributors to the success or failure of this transition. One hypothesis is that health literacy influences this transition from pediatric to adult health care. The purpose of this study was twofold: (a) to examine the relationship between caregiver and adolescent health literacy levels in adolescents with SCD; and (b) to further describe individual traits contributing to health literacy levels in adolescents with SCD as described by pilot data. DESIGN AND METHODS This cross-sectional, descriptive correlational study included the administration of the newest vital sign (NVS) health literacy instrument to 59 dyads of adolescent patients with SCD and their caregivers in a large, tertiary care center in Dallas, Texas. Convenience sampling was utilized for recruitment. Caregiver health literacy levels, age, current grade level, annual household income, caregiver education level, number of annual healthcare encounters, and adolescent health literacy levels were correlated to determine relationships amongst variables. RESULTS There was no significant relationship between caregiver and adolescent health literacy levels in this population. Adolescent health literacy NVS scores were positively correlated with adolescent age, r(58) = .468, p < .001, caregiver income, r(46) = .293, p = .023, and caregiver highest education level, r(56) = .318, p = .008. Only adolescent age was a significant predictor of adolescent health literacy NVS scores, β = .485 (standard error [SE] = .109), p = .001. None of the other predictors in the model were significant, including the relationship between caregiver and adolescent health literacy NVS scores, β = .065 (SE = .131), p = .633. In addition, although caregiver income and highest education level were positively correlated with adolescent health literacy NVS scores in the bivariate analysis, these relationships were nonsignificant while controlling for each other, adolescent age, and the other variables in the model. PRACTICE IMPLICATIONS This study gives insight on potential practice and research initiatives to evaluate the health literacy of adolescents, with and without SCD, both now and in the future.
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Mellerio H, Jacquin P, Trelles N, Le Roux E, Belanger R, Alberti C, Tubiana-Rufi N, Stheneur C, Guilmin-Crépon S, Devilliers H. Validation of the "Good2Go": the first French-language transition readiness questionnaire. Eur J Pediatr 2020; 179:61-71. [PMID: 31515671 DOI: 10.1007/s00431-019-03450-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/24/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
The use of transition readiness questionnaires is strongly recommended in adolescents with chronic conditions. The aim of our study was to validate "Good2Go," the first French-language transition readiness questionnaire. We analyzed the data from 2 multicentric studies (Canada and France) involving adolescents with chronic conditions (type 1 diabetes, inflammatory bowel disease, cystic fibrosis, epilepsy, juvenile idiopathic arthritis). Content and construct validity were examined using factorial and Rasch analysis (structural validity), Spearman's correlation, and Mann-Whitney test (external validity). Cronbach's α and intra-class correlation coefficients explored reliability. Cognitive interviews assessed wording comprehension and item appropriateness. Good2Go was completed by 321 participants (boys = 51%; mean age = 16.4 years (standard deviation = 1.5; min = 14.0; max = 18.0); Canada = 51.1%). Factor analysis identified 3 domains: "health self-advocacy," "knowledge about chronic conditions," and "self-management skills." The 3-domain structure showed a satisfying Rasch fit, internal consistency, and test-retest reliability. Good2Go domain scores were significantly higher in participants over 17 years of age, indicating satisfactory external validity.Conclusion: Good2Go is a valid 20-item questionnaire to assess transition readiness in adolescents with chronic conditions and may be useful in routine care to propose individually tailored preparation for their transfer to adult healthcare. Further research is now needed to analyze correlation between domain scores and success of transition.What is Known:• In adolescents with chronic conditions, the use of transition readiness questionnaires is recommended to propose individually tailored preparation for their transfer to adult healthcare.• However, no French-language questionnaire has been so far validated.What is New:• Based on a complete validation methodology, this study highlights that the French-language 20-items Good2Go questionnaire has good psychometric properties.• It explores all transition key points though 3 scored domains: "health self-advocacy", "knowledge about chronic disease" and "self-management skills".
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Affiliation(s)
- Hélène Mellerio
- Plateforme de transition Ad'venir, Unité de médecine d'adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, 75010, Paris, France. .,INSERM, ECEVE U1123 and CIC-EC, CIC 1426, 75010, Paris, France. .,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France. .,French Clinical Research Group in Adolescent Medicine and Health, 75014, Paris, France. .,RECaP Network-Perceived health measurement Working Group, Paris, France.
| | - Paul Jacquin
- Plateforme de transition Ad'venir, Unité de médecine d'adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,French Clinical Research Group in Adolescent Medicine and Health, 75014, Paris, France
| | - Nelson Trelles
- Service de chirurgie viscérale et digestive, Centre Hospitalier René Dubos, 95303, Pontoise, France
| | - Enora Le Roux
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, 75010, Paris, France.,INSERM, ECEVE U1123 and CIC-EC, CIC 1426, 75010, Paris, France.,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,RECaP Network-Perceived health measurement Working Group, Paris, France
| | - Richard Belanger
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec, Québec, QC, G1E 6W2, Canada.,Département de pédiatrie, Centre mère-enfant Soleil du CHU de Québec, Université Laval, Quebec, Canada
| | - Corinne Alberti
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, 75010, Paris, France.,INSERM, ECEVE U1123 and CIC-EC, CIC 1426, 75010, Paris, France.,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,RECaP Network-Perceived health measurement Working Group, Paris, France
| | - Nadia Tubiana-Rufi
- Service d'Endocrinologie et de Diabétologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France
| | - Chantal Stheneur
- Département de pédiatrie, CHU Saint Justine, Montréal, QC, Canada.,Faculté de médecine, Université de Montréal, Quebec, Canada
| | - Sophie Guilmin-Crépon
- Plateforme de transition Ad'venir, Unité de médecine d'adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, 75010, Paris, France.,INSERM, ECEVE U1123 and CIC-EC, CIC 1426, 75010, Paris, France.,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,Service d'Endocrinologie et de Diabétologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France
| | - Hervé Devilliers
- RECaP Network-Perceived health measurement Working Group, Paris, France.,Service de Médecine interne et Maladies systémiques (Médecine interne 2), Hôpital François-Mitterrand, 21079, Dijon cedex, France
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Clayton-Jones D, Matthie N, Treadwell M, Field JJ, Mager A, Sawdy R, George Dalmida S, Leonard C, Koch KL, Haglund K. Social and Psychological Factors Associated With Health Care Transition for Young Adults Living With Sickle Cell Disease. J Transcult Nurs 2019; 32:21-29. [PMID: 31889479 DOI: 10.1177/1043659619896837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Due to advances in disease management, mortality rates in children with sickle cell disease (SCD) have decreased. However, mortality rates for young adults (YA) increased, and understanding of social and psychological factors is critical. The aim of this study was to explore factors associated with health care transition experiences for YA with SCD. Method: This was a qualitative descriptive study. A 45-minute semistructured interview was conducted with 13 YA (M = 21.5 years, SD = 1.73). Results: Results suggest that social and psychological factors and self-management experiences influence health care transition. Eight themes emerged: "need for accessible support"; "early assistance with goal setting"; "incongruence among expectations, experiences, and preparation"; "spiritual distress"; "stigma"; "need for collaboration"; "appreciation for caring providers"; and "feeling isolated." Discussion: Consideration of cultural contexts will guide nurses in supporting health care transition. Designing culturally relevant interventions that address unique needs for YA living with SCD is warranted.
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Affiliation(s)
- Dora Clayton-Jones
- Marquette University College of Nursing, Milwaukee, WI, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nadine Matthie
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | | | | | - Amy Mager
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Sawdy
- Marquette University College of Nursing, Milwaukee, WI, USA
| | - Safiya George Dalmida
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Cynthia Leonard
- Froedtert Hospital Sickle Cell Disease Clinic, Milwaukee, WI, USA
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Darbari I, Jacobs E, Gordon O, Weiss D, Winship K, Casella JF, Strouse JJ, Takemoto CM. Correlates of successful transition in young adults with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27939. [PMID: 31429531 DOI: 10.1002/pbc.27939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Abstract
The transition period from pediatric care to adult care for patients with sickle cell disease (SCD) is associated with increased mortality and morbidity. Identification of risk factors for unsuccessful transition may aid in developing strategies to improve the transition process and health outcomes in this population. We examined factors associated with unsuccessful transition from pediatric to adult care for patients with SCD at the Johns Hopkins Hospital. We found that public insurance and increased hospitalization rates were associated with poor transition to adult care. The findings provide possible areas of intervention.
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Affiliation(s)
- Isha Darbari
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Emily Jacobs
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Olivia Gordon
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Diane Weiss
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Kim Winship
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - James F Casella
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - John J Strouse
- Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Clifford M Takemoto
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland.,Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Smith WR, Sisler IY, Johnson S, Lipato TJ, Newlin JS, Owens ZS, Morgan AM, Treadwell MJ, Polak K. Lessons Learned from Building a Pediatric-to-Adult Sickle Cell Transition Program. South Med J 2019; 112:190-197. [PMID: 30830235 DOI: 10.14423/smj.0000000000000950] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE More effective transitions and transfers of young people with sickle cell disease (SCD) into the adult healthcare setting is a focus of both primary care and specialty care medical organizations. Effective transition and transfer requires six core elements: establishing a policy, tracking progress, administering transition readiness assessments, planning for adult care, transferring to adult care, and integrating into an adult practice. We developed a program using these six core elements. The objective of our report was to assess the development and implementation of this program. METHODS We used the six core elements to develop and implement a program at Virginia Commonwealth University for children and adolescents with SCD to transition to adult health care. RESULTS We assessed individuals' differences by age and grade, their independent living skills, their feelings about moving to adult care; tallied and analyzed several assessment scales; and assessed transfer success and patient retention. CONCLUSIONS The principles and lessons we learned in developing and implementing this program over 5 years, accompanied by caring, flexible, and dedicated care team members, often can overcome even severe barriers to care transitions.
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Affiliation(s)
- Wally R Smith
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
| | - India Y Sisler
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
| | - Shirley Johnson
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
| | - Thokozeni J Lipato
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
| | - Jennifer S Newlin
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
| | - Zakiya S Owens
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
| | - Alma M Morgan
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
| | - Marsha J Treadwell
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
| | - Kathryn Polak
- From the Department of Internal Medicine, Division of General Internal Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Department of Psychology, Virginia Commonwealth University, Richmond, and Department of Hematology/Oncology, University of California, San Francisco Benioff Children's Hospital, San Francisco
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36
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Caldwell EP. The influence of health literacy on emergency department utilization and hospitalizations in adolescents with sickle cell disease. Public Health Nurs 2019; 36:765-771. [DOI: 10.1111/phn.12643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 11/30/2022]
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Calhoun CL, Abel RA, Pham HA, Thompson S, King AA. Implementation of an educational intervention to optimize self-management and transition readiness in young adults with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27722. [PMID: 30907500 PMCID: PMC6529244 DOI: 10.1002/pbc.27722] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/20/2019] [Accepted: 03/05/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The transition from the pediatric setting to adult care is a well-described period of morbidity and mortality for persons with sickle cell disease (SCD). We sought to measure the feasibility and effectiveness of providing skill-based educational handouts on improving self-management and transition readiness in adolescents with SCD. METHODS This was a single-center study in which participants completed a self-assessment, the Adolescent Autonomy Checklist (AAC), to assess transition readiness and self-management skills at baseline. After results were reviewed by the study coordinator, participants were provided with skill-based handouts on noted areas of deficit. The AAC was subsequently completed at a follow-up visit. All data were stored electronically and transferred into SAS for statistical analyses. RESULTS Sixty-one patients completed the AAC at baseline and postintervention. At baseline, patients reported needing the most help with skills in money management, living arrangements, vocational skills, and emergency and healthcare skills. Postintervention, statistically significant improvements (P < 0.05) occurred in skills related to laundry, housekeeping, healthcare, and sexual development. A regression model exploring the time to follow-up showed that most improvements could not be attributed to maturation alone. CONCLUSION This study showed that educational handouts are a readily implementable and well-accepted intervention among adolescents with SCD who identify challenges with skills necessary to successfully transition to adult care. Distinguishing which transition needs are best improved with this type of intervention will help to strengthen the multidisciplinary approach necessary to support adolescents and young adults with SCD as they matriculate to adult care.
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Affiliation(s)
- Cecelia L. Calhoun
- Department of Pediatrics, Division of Hematology Oncology, Washington University School of Medicine
- Department of Pediatrics, Division of Hematology OncologySiteman Cancer Center
| | - Regina A. Abel
- Department of Pediatrics, Division of Hematology Oncology, Program in Occupational Therapy
| | - Hai Ahn Pham
- Department of Pediatrics, Division of Hematology Oncology, Brown University
| | - Shomari Thompson
- Department of Pediatrics, Division of Hematology Oncology, Meharry Medical College School of Medicine
| | - Allison A. King
- Department of Pediatrics, Division of Hematology Oncology, Washington University School of Medicine
- Department of Pediatrics, Division of Hematology Oncology, Program in Occupational Therapy
- Department of Pediatrics, Division of Hematology OncologySiteman Cancer Center
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38
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Melita N, Diaz-Linhart Y, Kavanagh PL, Sobota A. Developing a Problem-solving Intervention to Improve Self-Management and Transition Readiness in Adolescents with Sickle Cell Disease. J Pediatr Nurs 2019; 46:26-32. [PMID: 30826724 DOI: 10.1016/j.pedn.2019.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE Adolescents and young adults (AYA) with sickle cell disease (SCD) are at risk for serious complications including increased morbidity and early mortality during their transition from pediatric to adult care. Self-management support may help improve transition outcomes in this vulnerable population. Interventions based on teaching problem solving skills have been shown to improve adherence to therapy for AYA with other chronic disease and is a promising intervention in SCD. We sought patient and parent perspectives on improving self-management and input on the development of a problem-solving education (PSE) intervention. DESIGN AND METHODS We held focus groups with AYA with SCD and caregivers to discuss barriers and facilitators of self-management, acceptability of PSE and intervention content and delivery. RESULTS Five focus groups were held with AYA (n = 17) and caregivers (n = 15). Groups participated jointly to discuss self-management and then separately to discuss PSE. Data were analyzed using grounded theory and double-coded until thematic saturation was achieved. CONCLUSIONS Both groups endorsed PSE as an acceptable intervention. Barriers to self-management included wanting to fit in with peers (AYA) and trouble letting go (parents); facilitators included having a regular routine (AYA) and sharing responsibility (parents). Participants suggested meeting in small groups for PSE sessions rather than individually and adding group sessions for parents. PRACTICAL IMPLICATIONS Understanding AYA and caregivers' perceptions of barriers and facilitators of transition in SCD can help us better prepare AYA for transition. The specifics both groups identified as helpful will guide intervention development.
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Affiliation(s)
- Nicole Melita
- Department of Pediatrics, Boston University Medical Center, Boston, MA, United States of America
| | - Yaminette Diaz-Linhart
- Department of Pediatrics, Boston University Medical Center, Boston, MA, United States of America
| | - Patricia L Kavanagh
- Department of Pediatrics, Boston University Medical Center, Boston, MA, United States of America
| | - Amy Sobota
- Department of Pediatrics, Boston University Medical Center, Boston, MA, United States of America.
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Kanter J, Bhor M, Li X, Li FY, Paulose J. High Healthcare Utilization in Adolescents with Sickle Cell Disease Prior to Transition to Adult Care: A Retrospective Study. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2019; 6:174-184. [PMID: 32685589 PMCID: PMC7299476 DOI: 10.36469/10512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND The transition from pediatric to adult care in the US is often difficult for individuals with sickle cell disease (SCD). Young adults (18 to 25 years of age) have higher acute care utilization and an increased risk of poor outcomes. The current study was designed to provide greater insights into patients (16 to 18 years of age) with SCD prior to their transition to adult care. OBJECTIVES To describe current treatment patterns, pain crises prevalence, SCD-related complications, and healthcare resource utilization (HCRU) in 16-to-18-year-old patients with SCD. METHODS From 1/1/2015-6/30/2017 using MarketScan Databases, patients were included if they were 16 to 18 years old at the index date, had ≥1 inpatient or 2 outpatient SCD diagnosis claims during the identification period, and were continuously enrolled in the database for at least one year prior (baseline) and post index date. Outcomes included medications, disease management interventions, Charlson Comorbidity Index (CCI), vaso-occlusive (VOC) crises requiring healthcare visits, HCRU, and SCD complications. RESULTS 1,186 patients were included; most (64.3%) were female. The mean CCI was 1.3 (SD: 0.7). In the overall cohort, patients experienced an average of 3.9 (SD: 4.2) VOCs and most patients (61.1%, n=725) had chronic complications during the one-year follow-up. Pulmonary disease (31.1%, n=369) was the most frequent complication; blood transfusions (mean: 8.4 [SD:7.0]) and iron-chelating therapies (mean: 8.6 [SD:10]) were the most common interventions and medications, respectively. In the 16 to 18 year old group, patients with SCD had 2.0 (SD = 2.3) hospital admissions, 3.4 (SD = 4.0) ER visits, and 5.0 (SD = 4.2) office visits. CONCLUSIONS Prior to transition to adult care, adolescents with SCD already have significant a cute and chronic disease-related complications, possibly contributing to frequent healthcare visits. Increased attention to this age group, including improvements in disease modifying therapy, are needed prior to transition to adult care systems to improve outcomes.
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Affiliation(s)
- Julie Kanter
- Institution: University of Alabama at Birmingham, Division of Hematology and Oncology
| | - Menaka Bhor
- Institution: Novartis Pharmaceuticals Corporation Department: U.S. Oncology Health Economics and Outcomes Research
| | - Xin Li
- Institution: Novartis Pharmaceuticals Corporation Department: U.S. Oncology Medical
| | - Frank Yunfeng Li
- Institution: Novartis Pharmaceuticals Corporation Department: U.S. Oncology Health Economics and Outcomes Research
| | - Jincy Paulose
- Institution: KMK Consulting Inc. Department: Health Economics and Outcome Research
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White PH, Cooley WC, Boudreau ADA, Cyr M, Davis BE, Dreyfus DE, Forlenza E, Friedland A, Greenlee C, Mann M, McManus M, Meleis AI, Pickler L. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics 2018; 142:peds.2018-2587. [PMID: 30348754 DOI: 10.1542/peds.2018-2587] [Citation(s) in RCA: 424] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.
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Affiliation(s)
- Patience H. White
- Got Transition/The National Alliance to Advance Adolescent Health and Department of Medicine and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and
| | - W. Carl Cooley
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Lanzkron S, Sawicki GS, Hassell KL, Konstan MW, Liem RI, McColley SA. Transition to adulthood and adult health care for patients with sickle cell disease or cystic fibrosis: Current practices and research priorities. J Clin Transl Sci 2018; 2:334-342. [PMID: 30828476 PMCID: PMC6390387 DOI: 10.1017/cts.2018.338] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION A growing population of adults living with severe, chronic childhood-onset health conditions has created a need for specialized health care delivered by providers who have expertise both in adult medicine and in those conditions. Optimal care of these patients requires systematic approaches to healthcare transition (HCT). Guidelines for HCT exist, but gaps in care occur, and there are limited data on outcomes of HCT processes. METHODS The Single Disease Workgroup of the Lifespan Domain Task Force of the National Center for Advancing Translational Sciences Clinical and Translational Science Award programs convened a group to review the current state of HCT and to identify gaps in research and practice. Using cystic fibrosis and sickle cell disease as models, key themes were developed. A literature search identified general and disease-specific articles. We summarized key findings. RESULTS We identified literature characterizing patient, parent and healthcare provider perspectives, recommendations for transition care, and barriers to effective transition. CONCLUSIONS With increased survival of patients with severe childhood onset diseases, ongoing study of effective transition practices is essential as survival increases for severe childhood onset diseases. We propose pragmatic methods to enhance transition research to improve health and key outcomes.
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Affiliation(s)
- Sophie Lanzkron
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kathryn L. Hassell
- Department of Medicine, Division of Hematology, Colorado Sickle Cell Treatment and Research Center, University of Colorado, Aurora, CO, USA
| | - Michael W. Konstan
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert I. Liem
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susanna A. McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Han AX, Whitehouse SR, Tsai S, Hwang S, Thorne S. Perceptions of the family physician from adolescents and their caregivers preparing to transition to adult care. BMC FAMILY PRACTICE 2018; 19:140. [PMID: 30134842 PMCID: PMC6106717 DOI: 10.1186/s12875-018-0830-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/14/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adolescents with chronic health conditions and/or disabilities (CHC/D's) often face challenges when transitioning to adult care, which leads to a higher risk of morbidity and mortality. Although it is recommended that establishing the medical home and family physician (FP) attachment prior to transfer will improve health outcomes, there is little evidence or policy surrounding the role of the FP during this transition. This study explores the described use of health services by adolescents with CHC/D's, as well as the adolescent's and caregiver's perceptions of their FP. METHODS Participants were recruited from the British Columbia Children's Hospital, Canada and a multi-method phased approach was used. In Phase 1, 84 adolescent and caregiver pairs completed questionnaires asking what medical services they accessed for specific health needs. In Phase 2, another cohort of 21 adolescent and caregiver pairs completed the same questionnaires and were interviewed regarding their perception of their FP. RESULTS 96% (n = 81) of adolescents with CHC/D's in phase 1 had a FP. Thirty four percent (n = 34) of adolescents had not seen their FP in the last 6 months. While adolescents with CHC/D mostly accessed their FP for primary health issues, they frequently also accessed specialists for prescription refills (50%, n = 51), mental health (29%, n = 30) and sexual health (16%, n = 16). While most adolescent/caregiver participants reported positive communication and trust in their FP, some had a poor understanding of the FP's role in coordinating care. CONCLUSION As many adolescents with CHC/D may see their FP infrequently and may not clearly understand their role, opportunities exist for strengthening primary care home attachment as well as adolescent and caregiver literacy around the potential contribution of the FP during and after transfer to adult services. Responsibility for improving care coordination for this population should be ideally shared between FPs and pediatric specialists.
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Affiliation(s)
- Angela Xiao Han
- University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3 Canada
| | | | - Steve Tsai
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
| | - Sandy Hwang
- Child Family Research Institute, 950 W 28th Ave, Vancouver, BC V5Z 4H4 Canada
| | - Sally Thorne
- University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
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Anderson LM, Leonard S, Jonassaint J, Lunyera J, Bonner M, Shah N. Mobile health intervention for youth with sickle cell disease: Impact on adherence, disease knowledge, and quality of life. Pediatr Blood Cancer 2018; 65:e27081. [PMID: 29693797 DOI: 10.1002/pbc.27081] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/25/2018] [Accepted: 03/06/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adherence to illness self-management among youth with sickle cell disease (SCD) positively impacts health outcomes and decreases overall healthcare costs. Despite this, children with SCD face several barriers to adherence, with adherence rates that remain moderate to low. The current feasibility study examined the Intensive Training Program (ITP), a mobile health (mHealth) intervention for youth with SCD designed to promote disease knowledge, adherence, and patient-provider communication. PROCEDURE Youth with SCD prescribed hydroxyurea between ages 7-18 completed baseline disease knowledge and psychosocial assessments and then were provided with the ITP app. Youth participated in the 90-day ITP, during which they completed three education modules, tracked adherence through daily self-recorded videos on the app, and received video messages from providers. Participants completed poststudy knowledge, psychosocial, and feasibility questionnaires. Medication possession ratio (MPR) was obtained via pharmacy-refill rates. RESULTS Thirty-two youths (mean age = 13.0 years) participated, with an average adherence tracking rate of 0.6 (standard deviation = 0.34). All participants demonstrated increased MPR (0.57-0.74, P < 0.001, d = 0.75) and disease knowledge (59.6-88.6%, P < 0.001). There was variable engagement in the ITP; completers demonstrated significantly better SCD-related functioning (P < 0.05), higher parent-reported treatment functioning (P < 0.05), and lower pain impact than noncompleters of the ITP (P < 0.05). CONCLUSIONS Results support the ITP can feasibly be implemented to promote adherence among youth with SCD. All participants demonstrated increased adherence and disease knowledge. However, there was variable engagement and only intervention completers showed improvements in psychosocial outcomes. Further research is needed to evaluate long-term outcomes and ways to promote engagement in mHealth interventions among the youth.
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Affiliation(s)
- Lindsay M Anderson
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Sarah Leonard
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.,Department of Pediatrics, Eastern Carolina University, Greenville, North Carolina
| | - Jude Jonassaint
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph Lunyera
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Melanie Bonner
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Nirmish Shah
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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Porter JS, Wesley KM, Zhao MS, Rupff RJ, Hankins JS. Pediatric to Adult Care Transition: Perspectives of Young Adults With Sickle Cell Disease. J Pediatr Psychol 2018. [PMID: 28637291 DOI: 10.1093/jpepsy/jsx088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives The aim of this study was to explore perspectives of transition and transition readiness of young adult patients (YAs) with sickle cell disease (SCD) who have transitioned to adult health care. Methods In all, 19 YAs with SCD (ages 18-30 years) participated in one of three focus groups and completed a brief questionnaire about transition topics. Transcripts were coded and emergent themes were examined using the social-ecological model of adolescent and young adult readiness for transition (SMART). Results Themes were consistent with most SMART components. Adult provider relationships and negative medical experiences emerged as salient factors. YAs ranked choosing an adult provider, seeking emergency care, understanding medications/medication adherence, knowing SCD complications, and being aware of the impact of health behaviors as the most important topics to include in transition programming. Conclusions The unique perspectives of YAs can inform the development and evaluation of SCD transition programming by incorporating the identified themes.
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Affiliation(s)
- Jerlym S Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Kimberly M Wesley
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Mimi S Zhao
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rebecca J Rupff
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jane S Hankins
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
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45
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Caldwell EP, Carter P, Becker H, Mackert M. The Use of the Newest Vital Sign Health Literacy Instrument in Adolescents With Sickle Cell Disease. J Pediatr Oncol Nurs 2018; 35:361-367. [DOI: 10.1177/1043454218767875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this article is to discuss the use of the Newest Vital Sign (NVS) health literacy instrument in adolescents with sickle cell disease. The NVS evaluates both literacy and numeracy (the ability to understand and work with numbers) as well as the ability to locate and apply information. It is important to validate the NVS for use in adolescents, as the only currently validated instrument, the Rapid Estimate of Adolescent Literacy in Medicine–Teen (REALM-Teen), does not measure numeracy or the ability to locate or apply information. This cross-sectional, descriptive, exploratory correlational study included appraisal of data from completion of the REALM-Teen and NVS instruments by a convenience sample of 75 adolescents with sickle cell disease. The mean age of this study sample was 14.7 years ( SD = 2.2). The mean grade level of participants was 8.7 ( SD = 2.2). Internal consistency for the NVS in this population was acceptable (α = .63). Criterion validity was based on correlations between raw scores on the NVS and raw scores on the REALM-Teen. There was a significant moderate, positive correlation between NVS and REALM-Teen scores ( r = .38, p < .01), demonstrating good criterion validity. Preliminary evidence for reliability and validity of the NVS in this population was established.
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Colinart-Thomas M, Noël V, Roques G, Gordes-Grosjean S, Abely M, Pluchart C. [From pediatric care to adult medicine: Transition of sickle cell patients, a French monocentric study]. Arch Pediatr 2018. [PMID: 29530458 DOI: 10.1016/j.arcped.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sickle cell disease, a hemoglobin disorder with autosomal recessive transmission, is one of the most common genetic diseases screened in France. Thanks to early management, 95% of sickle cell patients reach adulthood and require transition from pediatric care to adult care. Through a retrospective study of records from serious sickle cell patients over 17 years old, followed in the hematology-oncology pediatric unit of Reims University Hospital Center in France, we analyzed transition conditions, compared pediatric and adult management, and proposed a plan for transition care. As of 1 January 2016, out of 19 sickle cell patients meeting the inclusion criteria, 12 had made the transition from pediatric care to adult medicine. Among the transition group, the transition was proposed by the pediatrician in 92% of cases. The average age of transition was 19.4 years. The time between receiving the information and the last pediatric visit was 2.4 months. Seven out of the 12 patients were informed of their transition during the last pediatric visit. The age of the first adult visit was 20.3 years. There was no alternate or joint consultation. The treatments prescribed during the last pediatric visit were not modified during the first adult visit. The average number of hospitalizations per patient was 2.7 in pediatric care and 3.4 in adult care with a median value of 2 in both groups. Three out of 12 patients died, the average age of death being 26.7 years. Transition is an important milestone in chronic disease patients. More than age, the maturity of the patient must be taken into account. The transition to the adult structure requires early preparation in the teenage years and investment of the adolescent and his family as well as investment of pediatric and adult caregivers. This study points out the need to establish a transition plan within our hospital in collaboration with adult physicians. Continuity of care is necessary to increase the quality of managing patients and cannot be done without a close relationship between pediatric specialists and adult physicians.
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Affiliation(s)
- M Colinart-Thomas
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - V Noël
- Service de médecine interne, maladies infectieuses et immunologie clinique, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - G Roques
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Gordes-Grosjean
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M Abely
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - C Pluchart
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Abstract
Using descriptive case studies, this paper describes a short-term mentoring program using goal attainment scaling for young adults with sickle cell disease (SCD). Two participants received three and seven visits, respectively, before dropping out of the program with no significant change in goal attainment scores. Although the program supported meaningful individualized goals, repeated and cumulative effects of hospitalizations, sickle cell pain episodes, family health issues, unsafe location of residence, and transportation appeared to remain significant barriers for to achieve stated goals. While the value of an individualized, community-based mentoring experience that addresses goal attainment remains unanswered, this project documents the complex and health barriers of young adults living with SCD.
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Affiliation(s)
- Christine Berg
- a Program in Occupational Therapy , Washington University School of Medicine , St. Louis , Missouri , USA
| | - Allison King
- b Program in Occupational Therapy , Washington University School of Medicine , St. Louis , Missouri , USA
| | - Dorothy Farrar Edwards
- c Department of Kinesiology and Medicine, Core Leader Wisconsin Alzheimer's Disease Research Center Outreach Education and Recruitment and Minority Recruitment Cores, Director, Collaborative Center for Health Equity , University ofWisconsin, Madison , Madison , Wisconsin , USA
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Margolis R, Wiener L, Pao M, Malech HL, Holland SM, Driscoll P. Transition From Pediatric to Adult Care by Young Adults With Chronic Granulomatous Disease: The Patient's Viewpoint. J Adolesc Health 2017; 61:716-721. [PMID: 28947348 PMCID: PMC5701857 DOI: 10.1016/j.jadohealth.2017.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/22/2017] [Accepted: 06/25/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Children with chronic illnesses are living longer, prompting health care provider attention to the transition from pediatric to adult care. Transition of care is successful when youth are independent in managing their health. The aims of this study were to identify the strengths and barriers to transition from pediatric to adult care and to determine strategies that could enhance the transition process. METHODS A survey was administered via a structured interview to 33 young adult participants (19-27 years of age), living with chronic granulomatous disease all of whom transitioned from pediatric to adult care. The participants were predominately male (88%) and Caucasian (73%). Topics covered in the survey included understanding of disease and treatment, adherence, advance care planning, and barriers to transition. Data were analyzed using a conventional content analysis approach. RESULTS Seventy-six percent of the participants did not understand their disease process and only 50% understood their prophylactic medication regimen. Seventy-five percent of participants perceived their transition as uneventful. Ninety-four percent were independent in self-management skills such as making appointments and 90% in refilling prescriptions. More than half of the participants thought that the transition process needed improvement. Specific suggestions to create a practical approach to transition were offered. CONCLUSIONS Gaps in disease-related knowledge and transition planning were identified by adolescents and young adults living with chronic granulomatous disease. The findings suggest the need for enhancing the transition process utilizing interdisciplinary collaboration to develop a transition policy and program.
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Affiliation(s)
- Rachel Margolis
- Laboratory of Clinical Infectious Diseases, National Institute of
Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for
Cancer Research, National Institutes of Health, Bethesda, MD
| | - Maryland Pao
- National Institute of Mental Health, National Institutes of Health,
Bethesda, MD
| | - Harry L. Malech
- Laboratory of Host Defenses, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Steven M. Holland
- Laboratory of Clinical Infectious Diseases, National Institute of
Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Patricia Driscoll
- Intramural Clinical Management and Operations Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
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Zhao Y, Bailey JA, Linden J, St. Pierre P, Cerny J, Vauthrin M, Greene M, Weinstein R. Automated red blood cell exchange in preparation for filgrastim mobilization of autologous peripheral blood hematopoietic progenitor cells in a patient with sickle cell anemia. J Clin Apher 2017; 33:431-435. [DOI: 10.1002/jca.21602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yong Zhao
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
- Department of Pathology; University of Massachusetts Medical School; Worcester Massachusetts
| | - Jeffrey A. Bailey
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
- Department of Pathology; University of Massachusetts Medical School; Worcester Massachusetts
| | - Jeanne Linden
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Patricia St. Pierre
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Jan Cerny
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
- Division of Hematology/Oncology; UMass Memorial Medical Center; Worcester Massachusetts
| | - Michelle Vauthrin
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Mindy Greene
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Robert Weinstein
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
- Department of Pathology; University of Massachusetts Medical School; Worcester Massachusetts
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Kızıler E, Yıldız D, Eren Fidancı B. Validation of Transition Readiness Assessment Questionaire in Turkish Adolescents with Diabetes. Balkan Med J 2017; 35:93-100. [PMID: 29039345 PMCID: PMC5820454 DOI: 10.4274/balkanmedj.2016.1415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Today, more than 90% of adolescents with chronic conditions survive into adulthood and move from pediatric care to adult care for the management of their chronic illness. It is important to grant autonomy and ensure that adolescents/young adults are ready to use the adult health care system prior to the transfer of care. However, the lack of a transition readiness assessment tool that is validated, patient-centered, and appropriate to developmental differences in pediatric care is a major obstacle for the transition of care from pediatric services to adult services. AIMS This study examined the validity and reliability of the Turkish version of the Transition Readiness Assessment Questionnaire, which assesses the readiness for transition from pediatric to adult health care for adolescents/young adults with diabetes mellitus. STUDY DESIGN Methodological study. METHODS Participants were 109 adolescents/young adults with type 1 diabetes mellitus aged 14-21 years. After permission was obtained to adapt the Transition Readiness Assessment Questionnaire, the Turkish Transition Readiness Assessment Questionnaire and self-care scale were administered to participants through face-to-face interviews at two pediatric endocrinology clinics. Validity was evaluated by exploratory and confirmatory factor analysis and content-scope validity assessment; reliability was evaluated by item-total score correlation and continuity methods. Internal reliability was assessed by Cronbach's alpha coefficient and criterion validity assessment. RESULTS The item analysis, exploratory factor analysis, and confirmatory factor analysis identified five basic dimensions, with high internal consistency (0.89-0.75). The ratio χ2/df and other conformity indices were a good fit to the data. The correlation coefficient in the analyses of test-retest scores was 0.86 for the total scale (p<0.05), and the Cronbach's alpha coefficient was 0.88 for overall scale. CONCLUSION The Turkish Transition Readiness Assessment Questionnaire is a valid and reliable measure of the transition readiness of adolescents/young adults with diabetes mellitus in Turkey. The Transition Readiness Assessment Questionnaire assesses the self-management abilities and health care transition knowledge of adolescents/young adults with diabetes mellitus who need special health care. It can also serve as a guide for health care professionals in detecting the educational fields that are necessary for acquiring self-management and self-care abilities.
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Affiliation(s)
- Evrim Kızıler
- Clinic of Pediatrics, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Dilek Yıldız
- Department of Pediatric Nursing, University of Health Sciences, Gülhane School of Nursing, Ankara, Turkey
| | - Berna Eren Fidancı
- Department of Pediatric Nursing, University of Health Sciences, Gülhane School of Nursing, Ankara, Turkey
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