1
|
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.
Collapse
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
| |
Collapse
|
2
|
Knisely MR, Masese RV, Mathias JG, Yang Q, Hatch D, Lê BM, Luyster F, Garrett ME, Tanabe PJ, Shah NR, Ashley-Koch A. Epigenetic Aging Associations With Psychoneurological Symptoms and Social Functioning in Adults With Sickle Cell Disease. Biol Res Nurs 2024:10998004241250322. [PMID: 38679469 DOI: 10.1177/10998004241250322] [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: 05/01/2024]
Abstract
Objective: Sickle cell disease (SCD), the most common inherited blood disorder in the United States, is associated with severe psychoneurological symptoms. While epigenetic age acceleration has been linked to psychoneurological symptom burden in other diseases, this connection is unexplored in SCD. This study aimed to assess the association between epigenetic age acceleration and psychoneurological symptom burden in SCD. Methods: In this cross-sectional study, emotional impact, pain impact, sleep impact, social functioning, and cognitive function were assessed in 87 adults living with SCD. DNA methylation data were generated from blood specimens and used to calculate epigenetic age using five clocks (Horvath, Hannum, PhenoAge, GrimAge, & DunedinPACE). Associations between epigenetic age acceleration and symptoms were assessed. Results: The sample (N = 87) had a mean (SD) chronologic age was 30.6 (8.1) years. Epigenetic age acceleration was associated with several symptom outcomes. GrimAge age acceleration (β = -0.49, p = .03) and increased DunedinPACE (β = -2.23, p = .004) were associated with worse emotional impact scores. PhenoAge (β = -0.32, p = .04) and the GrimAge (β = -0.48, p = .05) age acceleration were associated with worse pain impact scores. Increased DunedinPACE (β = -2.07 p = .04) were associated with worse sleep impact scores. Increased DunedinPACE (β = -2.87, p = .005) was associated with worse social functioning scores. We did not find associations between epigenetic age acceleration and cognitive function in this sample. Conclusion: Epigenetic age acceleration was associated with worse symptom experiences, suggesting the potential for epigenetic age acceleration as a biomarker to aid in risk stratification or targets for intervention to mitigate symptom burden in SCD.
Collapse
Affiliation(s)
| | - Rita V Masese
- Center for Bioethics, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joacy G Mathias
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Qing Yang
- Duke University School of Nursing, Durham, NC, USA
| | - Daniel Hatch
- Duke University School of Nursing, Durham, NC, USA
| | - Brandon M Lê
- Duke Molecular Physiology Institute, Durham, NC, USA
| | - Faith Luyster
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | | | - Nirmish R Shah
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Allison Ashley-Koch
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
3
|
Nwosu C, Khan H, Masese R, Nocek JM, Gollan S, Varughese T, Bourne S, Clesca C, Jacobs SR, Baumann A, Klesges LM, Shah N, Hankins JS, Smeltzer MP. Recruitment Strategies in the Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization Study (meSH): Multicenter Survey Study. JMIR Form Res 2024; 8:e48767. [PMID: 38625729 PMCID: PMC11061784 DOI: 10.2196/48767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Hydroxyurea is an evidence-based disease-modifying therapy for sickle cell disease (SCD) but is underutilized. The Integration of Mobile Health into Sickle Cell Disease Care to Increase Hydroxyurea Utilization (meSH) multicenter study leveraged mHealth to deliver targeted interventions to patients and providers. SCD studies often underenroll; and recruitment strategies in the SCD population are not widely studied. Unanticipated events can negatively impact enrollment, making it important to study strategies that ensure adequate study accrual. OBJECTIVE The goal of this study was to evaluate enrollment barriers and the impact of modified recruitment strategies among patients and providers in the meSH study in response to a global emergency. METHODS Recruitment was anticipated to last 2 months for providers and 6 months for patients. The recruitment strategies used with patients and providers, new recruitment strategies, and recruitment rates were captured and compared. To document recruitment adaptations and their reasons, study staff responsible for recruitment completed an open-ended 9-item questionnaire eliciting challenges to recruitment and strategies used. Themes were extrapolated using thematic content analysis. RESULTS Total enrollment across the 7 sites included 89 providers and 293 patients. The study acceptance rate was 85.5% (382/447) for both patients and providers. The reasons patients declined participation were most frequently a lack of time and interest in research, while providers mostly declined because of self-perceived high levels of SCD expertise, believing they did not need the intervention. Initially, recruitment involved an in-person invitation to participate during clinic visits (patients), staff meetings (providers), or within the office (providers). We identified several important recruitment challenges, including (1) lack of interest in research, (2) lack of human resources, (3) unavailable physical space for recruitment activities, and (4) lack of documentation to verify eligibility. Adaptive strategies were crucial to alleviate enrollment disruptions due to the COVID-19 pandemic. These included remote approaching and consenting (eg, telehealth, email, and telephone) for patients and providers. Additionally, for patients, recruitment was enriched by simplification of enrollment procedures (eg, directly approaching patients without a referral from the provider) and a multitouch method (ie, warm introductions with flyers, texts, and patient portal messages). We found that patient recruitment rates were similar between in-person and adapted (virtual with multitouch) approaches (167/200, 83.5% and 126/143, 88.1%, respectively; P=.23). However, for providers, recruitment was significantly higher for in-person vs remote recruitment (48/50, 96% and 41/54, 76%, respectively, P<.001). CONCLUSIONS We found that timely adaptation in recruitment strategies secured high recruitment rates using an assortment of enriched remote recruitment strategies. Flexibility in approach and reducing the burden of enrollment procedures for participants aided enrollment. It is important to continue identifying effective recruitment strategies in studies involving patients with SCD and their providers and the impact and navigation of recruitment challenges. TRIAL REGISTRATION ClinicalTrials.Gov NCT03380351; https://clinicaltrials.gov/study/NCT03380351. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/16319.
Collapse
Affiliation(s)
- Chinonyelum Nwosu
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Hamda Khan
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Judith M Nocek
- University of Illinois at Chicago, Chicago, IL, United States
| | | | - Taniya Varughese
- Washington University School of Medicine, St Louis, MO, United States
| | - Sarah Bourne
- Medical University of South Carolina, Charleston, SC, United States
| | - Cindy Clesca
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sara R Jacobs
- RTI International, Research Triangle Park, NC, United States
| | - Ana Baumann
- Washington University School of Medicine, St Louis, MO, United States
| | - Lisa M Klesges
- Washington University School of Medicine, St Louis, MO, United States
| | | | - Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | | |
Collapse
|
4
|
Mendez GG, Nocek JM, Brambilla DJ, Jacobs S, Cole O, Kanter J, Glassberg J, Saving KL, Melvin CL, Gibson RW, Treadwell M, Jackson GL, King AA, Gordeuk VR, Kroner B, Hsu LL. Social determinants of health and treatment center affiliation: analysis from the sickle cell disease implementation consortium registry. BMC Health Serv Res 2024; 24:291. [PMID: 38448911 PMCID: PMC10916176 DOI: 10.1186/s12913-024-10717-6] [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: 11/08/2022] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Adults with sickle cell disease (SCD) suffer early mortality and high morbidity. Many are not affiliated with SCD centers, defined as no ambulatory visit with a SCD specialist in 2 years. Negative social determinants of health (SDOH) can impair access to care. HYPOTHESIS Negative SDOH are more likely to be experienced by unaffiliated adults than adults who regularly receive expert SCD care. METHODS Cross-sectional analysis of the SCD Implementation Consortium (SCDIC) Registry, a convenience sample at 8 academic SCD centers in 2017-2019. A Distressed Communities Index (DCI) score was assigned to each registry member's zip code. Insurance status and other barriers to care were self-reported. Most patients were enrolled in the clinic or hospital setting. RESULTS The SCDIC Registry enrolled 288 Unaffiliated and 2110 Affiliated SCD patients, ages 15-45y. The highest DCI quintile accounted for 39% of both Unaffiliated and Affiliated patients. Lack of health insurance was reported by 19% of Unaffiliated versus 7% of Affiliated patients. The most frequently selected barriers to care for both groups were "previous bad experience with the healthcare system" (40%) and "Worry about Cost" (17%). SCD co-morbidities had no straightforward trend of association with Unaffiliated status. The 8 sites' results varied. CONCLUSION The DCI economic measure of SDOH was not associated with Unaffiliated status of patients recruited in the health care delivery setting. SCDIC Registrants reside in more distressed communities than other Americans. Other SDOH themes of affordability and negative experiences might contribute to Unaffiliated status. Recruiting Unaffiliated SCD patients to care might benefit from systems adopting value-based patient-centered solutions.
Collapse
Grants
- 3U01HL134042-04S2 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- 5U01HL134042-S2 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NIH HHS
- NIH
Collapse
Affiliation(s)
- Gustavo G Mendez
- University of Illinois Chicago, 840 S. Wood St., MC 856 Pediatrics, 60612, Chicago, IL, USA
| | - Judith M Nocek
- University of Illinois Chicago, 840 S. Wood St., MC 856 Pediatrics, 60612, Chicago, IL, USA
| | | | - Sara Jacobs
- RTI International, Research Triangle Park, USA
| | | | - Julie Kanter
- University of Alabama at Birmingham, Birmingham, USA
| | | | - Kay L Saving
- University of Illinois College of Medicine at Peoria, Peoria, USA
| | | | | | | | - George L Jackson
- Duke University, Durham, USA
- Durham Veterans Affairs Health Care System, Durham, USA
- University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Victor R Gordeuk
- University of Illinois Chicago, 840 S. Wood St., MC 856 Pediatrics, 60612, Chicago, IL, USA
| | | | - Lewis L Hsu
- University of Illinois Chicago, 840 S. Wood St., MC 856 Pediatrics, 60612, Chicago, IL, USA.
| |
Collapse
|
5
|
Lê BM, Hatch D, Yang Q, Shah N, Luyster FS, Garrett ME, Tanabe P, Ashley-Koch AE, Knisely MR. Characterizing epigenetic aging in an adult sickle cell disease cohort. Blood Adv 2024; 8:47-55. [PMID: 37967379 PMCID: PMC10784677 DOI: 10.1182/bloodadvances.2023011188] [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: 08/10/2023] [Revised: 10/20/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023] Open
Abstract
ABSTRACT Sickle cell disease (SCD) affects ∼100 000 predominantly African American individuals in the United States, causing significant cellular damage, increased disease complications, and premature death. However, the contribution of epigenetic factors to SCD pathophysiology remains relatively unexplored. DNA methylation (DNAm), a primary epigenetic mechanism for regulating gene expression in response to the environment, is an important driver of normal cellular aging. Several DNAm epigenetic clocks have been developed to serve as a proxy for cellular aging. We calculated the epigenetic ages of 89 adults with SCD (mean age, 30.64 years; 60.64% female) using 5 published epigenetic clocks: Horvath, Hannum, PhenoAge, GrimAge, and DunedinPACE. We hypothesized that in chronic disease, such as SCD, individuals would demonstrate epigenetic age acceleration, but the results differed depending on the clock used. Recently developed clocks more consistently demonstrated acceleration (GrimAge, DunedinPACE). Additional demographic and clinical phenotypes were analyzed to explore their association with epigenetic age estimates. Chronological age was significantly correlated with epigenetic age in all clocks (Horvath, r = 0.88; Hannum, r = 0.89; PhenoAge, r = 0.85; GrimAge, r = 0.88; DunedinPACE, r = 0.34). The SCD genotype was associated with 2 clocks (PhenoAge, P = .02; DunedinPACE, P < .001). Genetic ancestry, biological sex, β-globin haplotypes, BCL11A rs11886868, and SCD severity were not associated. These findings, among the first to interrogate epigenetic aging in adults with SCD, demonstrate epigenetic age acceleration with recently developed epigenetic clocks but not older-generation clocks. Further development of epigenetic clocks may improve their predictive ability and utility for chronic diseases such as SCD.
Collapse
Affiliation(s)
- Brandon M. Lê
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | | | - Qing Yang
- School of Nursing, Duke University, Durham, NC
| | - Nirmish Shah
- Department of Medicine, Division of Pediatric Hematology/Oncology, Duke University, Durham, NC
| | | | - Melanie E. Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | | | | | - Allison E. Ashley-Koch
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
- Department of Medicine, Duke University Medical Center, Durham, NC
| | | |
Collapse
|
6
|
Palermo TM, Lalloo C, Zhou C, Dampier C, Zempsky W, Badawy SM, Bakshi N, Ko YJ, Nishat F, Stinson JN. A cognitive-behavioral digital health intervention for sickle cell disease pain in adolescents: a randomized, controlled, multicenter trial. Pain 2024; 165:164-176. [PMID: 37733479 PMCID: PMC10723646 DOI: 10.1097/j.pain.0000000000003009] [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: 03/27/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 09/23/2023]
Abstract
ABSTRACT Severe acute and chronic pain are the most common complications of sickle cell disease (SCD). Pain results in disability, psychosocial distress, repeated clinic visits/hospitalizations, and significant healthcare costs. Psychosocial pain interventions that teach cognitive and behavioral strategies for managing pain have been effective in other adolescent populations when delivered in person or through digital technologies. Our aim was to conduct a multisite, randomized, controlled trial to improve pain and coping in youth aged 12 to 18 years with SCD using a digital cognitive-behavioral therapy program (iCanCope with Sickle Cell Disease; iCC-SCD) vs Education control. We enrolled 137 participants (ages 12-18 years, 59% female) and analyzed 111 adolescents (107 caregivers), 54 randomized to Education control and 57 randomized to iCC-SCD. Ninety-two percent of youth completed posttreatment assessments and 88% completed 6-month follow-up. There was a significant effect of treatment group (iCC-SCD vs Education) on reduction in average pain intensity from baseline to 6-month follow-up (b = -1.32, P = 0.009, 95% CI [-2.29, -0.34], d = 0.50), and for the number of days with pain, adolescents in the iCC-SCD group demonstrated fewer pain days compared with the Education group at 6-month follow-up (incident rate ratio = 0.63, P = 0.006, 95% CI [0.30, 0.95], d = 0.53). Treatment effects were also found for coping attempts, momentary mood, and fatigue. Several secondary outcomes did not change with intervention, including anxiety, depression, pain interference, and global impression of change. Future studies are needed to identify effective implementation strategies to bring evidence-based cognitive-behavioral therapy for sickle cell pain to SCD clinics and communities.
Collapse
Affiliation(s)
- Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Carlton Dampier
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - William Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, United States
| | - Sherif M. Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Nitya Bakshi
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Yeon Joo Ko
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Fareha Nishat
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Hankins JS, Brambilla D, Potter MB, Kutlar A, Gibson R, King AA, Baumann AA, Melvin C, Gordeuk VR, Hsu LL, Nwosu C, Porter JS, Alberts NM, Badawy SM, Simon J, Glassberg JA, Lottenberg R, DiMartino L, Jacobs S, Fernandez ME, Bosworth HB, Klesges LM, Shah N. A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease. Blood Adv 2023; 7:7190-7201. [PMID: 37738155 PMCID: PMC10698253 DOI: 10.1182/bloodadvances.2023010670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167.
Collapse
Affiliation(s)
- Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Robert Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Allison A King
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Victor R Gordeuk
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Chinonyelum Nwosu
- 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
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sherif M Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jena Simon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Sara Jacobs
- RTI International, Research Triangle Park, NC
| | - Maria E Fernandez
- Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hayden B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Medical Center, Durham, NC
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Nirmish Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC
| |
Collapse
|
8
|
Baumann AA, Hankins JS, Hsu LL, Gibson RW, Richardson LD, Treadwell M, Glassberg JA, Bourne S, Luo L, Masese RV, Demartino T, Nocek J, Taaffe E, Gollan S, Ruiz OO, Nwosu C, Qashou N, James AS, Tanabe P, King AA. "The project did not come to us with a solution": Perspectives of research teams on implementing a study about electronic health record-embedded individualized pain plans for emergency department treatment of vaso-occlusive episodes in adults with sickle cell disease. BMC Health Serv Res 2023; 23:1245. [PMID: 37953236 PMCID: PMC10641983 DOI: 10.1186/s12913-023-10255-7] [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: 05/24/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND This study aimed to capture the implementation process of the ALIGN Study, (An individualized Pain Plan with Patient and Provider Access for Emergency Department care of Sickle Cell Disease). ALIGN aimed to embed Individualized Pain Plans in the electronic health record (E-IPP) and provide access to the plan for both adult patients with sickle cell disease (SCD) and emergency department providers when a person with SCD comes to the emergency department in vaso-occlusive crises. METHODS Semi-structured interviews were conducted with research teams from the 8 participating sites from the ALIGN study. Seventeen participants (principal investigators and study coordinators) shared their perspectives about the implementation of ALIGN in their sites. Data were analyzed in three phases using open coding steps adapted from grounded theory and qualitative content analysis. RESULTS A total of seven overarching themes were identified: (1) the E-IPP structure (location and upkeep) and collaboration with the informatics team, (2) the role of ED champion, (3) the role of research coordinators, (4) research team communication, and communication between research team and clinical team, (5) challenges with the study protocol, (6) provider feedback: addressing over-utilizers, patient mistrust, and the positive feedback about the intervention, and (7) COVID-19 and its effects on study implementation. CONCLUSIONS Findings from this study contribute to learning how to implement E-IPPs for adult patients with SCD in ED. The study findings highlight the importance of early engagement with different team members, a champion from the emergency department, study coordinators with different skills and enhancement of communication and trust among team members. Further recommendations are outlined for hospitals aiming to implement E-IPP for patients with SCD in ED.
Collapse
Grants
- U24 HL133948 NHLBI NIH HHS
- U01 HL134042 NHLBI NIH HHS
- U01 HL133994 NHLBI NIH HHS
- U01 HL133964 NHLBI NIH HHS
- U01 HL134007 NHLBI NIH HHS
- U01 HL133997 NHLBI NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NHLBI NIH HHS
- U01 HL134004 NHLBI NIH HHS
- U01 HL133990 NHLBI NIH HHS
- U01 HL133996 NHLBI NIH HHS
- National Heart, Lung, and Blood Institute
- National Institute on Minority Health and Health Disparities
Collapse
Affiliation(s)
- Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA.
| | - Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Lynne D Richardson
- Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, New York City, NY, USA
| | - Marsha Treadwell
- Department of Pediatrics, Division of Hematology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Bourne
- Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, USA
| | - Lingzi Luo
- School of Global Public Health, New York University, New York City, NY, USA
| | | | | | - Judith Nocek
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth Taaffe
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
| | | | - Ome-Ollin Ruiz
- Department of Pediatrics, Division of Hematology, University of California San Francisco, San Francisco, CA, USA
| | - Chinonyelum Nwosu
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Hematology, St. Jude, Memphis, TN, USA
| | - Nai Qashou
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA
| | - Paula Tanabe
- Duke University School of Nursing, Durham, NC, USA
| | - Allison A King
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
| |
Collapse
|
9
|
Egiebor IC, McCleary KJ, Banta JE, Mataya R, Shih W. Understanding multi-level barriers to medication adherence among adults living with sickle cell disease. Medicine (Baltimore) 2023; 102:e35400. [PMID: 37832127 PMCID: PMC10578734 DOI: 10.1097/md.0000000000035400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023] Open
Abstract
There is limited research that identifies and examines multi-level barriers to medication adherence among adults with Sickle Cell Disease (SCD); Identify multi-level barriers to medication adherence among adults with SCD; and Examine the relationship between multi-level barriers and medication adherence levels. A cross-sectional study included 130 adults (ages ≥ 18 years old) living with SCD who receive treatment/care from one of the 10 adult SCD clinics within the Networking California for sickle cell care initiative. Study measures included the medication adherence report scale (Professor Rob Horne), Beliefs about Medicine Questionnaire (Professor Rob Horne), and patient reported outcomes measurement information system. Participants reported barriers to medication adherence across 3 levels: Community-level barriers (e.g., COVID-19 pandemic); Institutional-level barriers (e.g., bad experiences with the health care system); and Individual-level barriers (e.g., beliefs and depression severity). Depression severity and patient concerns about SCD medication were inversely correlated with medication adherence (rs = -0.302, P < .001; rs = -0.341, P < .001 respectively). Patient beliefs about the necessity of SCD medication were insignificantly correlated with medication adherence (rs = 0.065, P = .464). Medication adherence was higher among patients who had fewer adherence barriers than multiple adherence barriers (Median medication adherence: fewer barriers = 22 vs multiple barrier = 20.50, P = .085), suggesting clinical significance although statistically insignificant. Identifying multi-level adherence barriers and examining their relationship with medication adherence will help develop targeted public health strategies to promote improved medication adherence and wellness among adults with SCD.
Collapse
Affiliation(s)
- Ivie C. Egiebor
- Loma Linda University, School of Public Health, Loma Linda, CA
| | | | - Jim E. Banta
- Loma Linda University, School of Public Health, Loma Linda, CA
| | - Ronald Mataya
- Maternal and Child Health, Loma Linda University, School of Public Health, Loma Linda, CA
| | - Wendy Shih
- Loma Linda University, School of Public Health, Loma Linda, CA
| |
Collapse
|
10
|
Babu BV, Sharma Y, Surti SB, Bhat D, Sridevi P, Ranjit M, Sudhakar G, Sarmah J. Indian sickle cell disease registry for surveillance and patient management: Development and implementation. Int J Health Plann Manage 2023; 38:1483-1494. [PMID: 37340519 DOI: 10.1002/hpm.3674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/14/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023] Open
Abstract
In India, sickle cell disease (SCD) predominantly occurs in indigenous (tribal) people, who are about 104 million. However, screening and diagnosis seldom happen. This situation necessitates developing a comprehensive SCD care model, including a registry. This paper describes the development and implementation of the Indian SCD registry (ISCDR) in six tribal-dominated districts of India. The ISCDR was created in two components-(i) an Android-based mobile/tablet application, (ii) a dashboard/admin panel for patients' data management and retrieval. Data capture involves two electronic case report forms (CRF), that is, the primary form (CRF-1) and the repeat visit form (CRF-2). CRF-1 is completed as soon as the patient is found positive and captures the patient's information, including medical history, diagnosis, symptoms, precipitating factors, hospitalisation history and treatment received. Issues related to quality, security and data-sharing were addressed. After the screening system was functional, ISCDR was initiated. In 12 months, data of 324 SCD patients and 1771 carriers were entered. The study demonstrates the feasibility of establishing an SCD registry in India. It collects systematic longitudinal data on SCD patients, which are essential for programme planning and management. Further, it is feasible to scale up and integrate with other health management databases.
Collapse
Affiliation(s)
- Bontha V Babu
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
| | - Yogita Sharma
- Division of Socio-Behavioural, Health Systems & Implementation Research, Indian Council of Medical Research, New Delhi, India
| | - Shaily B Surti
- Department of Community Medicine, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India
| | - Deepa Bhat
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Parikipandla Sridevi
- Department of Biotechnology, Indira Gandhi National Tribal University, Amarkantak, India
| | - Manoranjan Ranjit
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Godi Sudhakar
- Department of Human Genetics, Andhra University, Visakhapatnam, India
| | - Jatin Sarmah
- Department of Biotechnology, Bodoland University, Kokrajhar, India
| |
Collapse
|
11
|
Howell KE, Pugh N, Longoria J, Shah N, Kutlar A, Gordeuk VR, King AA, Glassberg J, Kayle M, Melvin C, Treadwell M, Hankins JS, Porter JS. Burden of Aging: Health Outcomes Among Adolescents and Young Adults With Sickle Cell Disease. Hemasphere 2023; 7:e930. [PMID: 37456969 PMCID: PMC10348722 DOI: 10.1097/hs9.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Kristen E. Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Norma Pugh
- RTI International, Research Triangle Park, NC, USA
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, USA
| | - Abdullah Kutlar
- Department of Medicine, Augusta University, Augusta, GA, USA
| | | | - Allison A. King
- Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mariam Kayle
- Clinical Health Systems and Analytics Division, Duke University, Durham, NC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marsha Treadwell
- Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, San Francisco, CA, USA
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|
12
|
Singh A, Sontag MK, Zhou M, Dasgupta M, Crume T, McLemore M, Galadanci N, Randall E, Steiner N, Brandow AM, Koch K, Field JJ, Hassell K, Snyder AB, Kanter J. Evaluating the Discriminatory Ability of the Sickle Cell Data Collection Program's Administrative Claims Case Definition in Identifying Adults With Sickle Cell Disease: Validation Study. JMIR Public Health Surveill 2023; 9:e42816. [PMID: 37379070 PMCID: PMC10365593 DOI: 10.2196/42816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) was first recognized in 1910 and identified as a genetic condition in 1949. However, there is not a universal clinical registry that can be used currently to estimate its prevalence. The Sickle Cell Data Collection (SCDC) program, funded by the Centers for Disease Control and Prevention, funds state-level grantees to compile data within their states from various sources including administrative claims to identify individuals with SCD. The performance of the SCDC administrative claims case definition has been validated in a pediatric population with SCD, but it has not been tested in adults. OBJECTIVE The objective of our study is to evaluate the discriminatory ability of the SCDC administrative claims case definition to accurately identify adults with SCD using Medicaid insurance claims data. METHODS Our study used Medicaid claims data in combination with hospital-based medical record data from the Alabama, Georgia, and Wisconsin SCDC programs to identify individuals aged 18 years or older meeting the SCDC administrative claims case definition. In order to validate this definition, our study included only those individuals who were identified in both Medicaid's and the partnering clinical institution's records. We used clinical laboratory tests and diagnostic algorithms to determine the true SCD status of this subset of patients. Positive predictive values (PPV) are reported overall and by state under several scenarios. RESULTS There were 1219 individuals (354 from Alabama and 865 from Georgia) who were identified through a 5-year time period. The 5-year time period yielded a PPV of 88.4% (91% for data from Alabama and 87% for data from Georgia), when only using data with laboratory-confirmed (gold standard) cases as true positives. With a narrower time period (3-year period) and data from 3 states (Alabama, Georgia, and Wisconsin), a total of 1432 individuals from these states were included in our study. The overall 3-year PPV was 89.4% (92%, 93%, and 81% for data from Alabama, Georgia, and Wisconsin, respectively) when only considering laboratory-confirmed cases as true cases. CONCLUSIONS Adults identified as having SCD from administrative claims data based on the SCDC case definition have a high probability of truly having the disease, especially if those hospitals have active SCD programs. Administrative claims are thus a valuable data source to identify adults with SCD in a state and understand their epidemiology and health care service usage.
Collapse
Affiliation(s)
- Ashima Singh
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Marci K Sontag
- Center for Public Health Innovation, CI International, Littleton, CO, United States
| | - Mei Zhou
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, United States
| | - Mahua Dasgupta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Tessa Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Center, Aurora, CO, United States
| | - Morgan McLemore
- Department of Hematology and Oncology, Winship Cancer Institute, Emory School of Medicine, Atlanta, GA, United States
| | - Najibah Galadanci
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL, United States
| | - Eldrida Randall
- Department of Hematology and Oncology, Winship Cancer Institute, Emory School of Medicine, Atlanta, GA, United States
| | - Nicole Steiner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Amanda M Brandow
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kathryn Koch
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joshua J Field
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
- Versiti Blood Center of Wisconsin, Milwaukee, WI, United States
| | | | - Angela B Snyder
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, United States
| | - Julie Kanter
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL, United States
| |
Collapse
|
13
|
Harris KM, Preiss L, Varughese T, Bauer A, Calhoun CL, Treadwell M, Masese R, Hankins JS, Hussain FA, Glassberg J, Melvin CL, Gibson R, King AA. Examining Mental Health, Education, Employment, and Pain in Sickle Cell Disease. JAMA Netw Open 2023; 6:e2314070. [PMID: 37200033 PMCID: PMC10196879 DOI: 10.1001/jamanetworkopen.2023.14070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/21/2023] [Indexed: 05/19/2023] Open
Abstract
Importance Pain related to sickle cell disease (SCD) is complex and associated with social determinants of health. Emotional and stress-related effects of SCD impact daily quality of life and the frequency and severity of pain. Objective To explore the association of educational attainment, employment status, and mental health with pain episode frequency and severity among individuals with SCD. Design, Setting, and Participants This is a cross-sectional analysis of patient registry data collected at baseline (2017-2018) from patients treated at 8 sites of the US Sickle Cell Disease Implementation Consortium. Data analysis was performed from September 2020 to March 2022. Main Outcomes and Measures Electronic medical record abstraction and a participant survey provided demographic data, mental health diagnosis, and Adult Sickle Cell Quality of Life Measurement Information System pain scores. Multivariable regression was used to examine the associations of education, employment, and mental health with the main outcomes (pain frequency and pain severity). Results The study enrolled a total of 2264 participants aged 15 to 45 years (mean [SD] age, 27.9 [7.9] years; 1272 female participants [56.2%]) with SCD. Nearly one-half of the participant sample reported taking daily pain medication (1057 participants [47.0%]) and/or hydroxyurea use (1091 participants [49.2%]), 627 participants (28.0%) received regular blood transfusion, 457 (20.0%) had a depression diagnosis confirmed by medical record abstraction, 1789 (79.8%) reported severe pain (rated most recent pain crises as ≥7 out of 10), and 1078 (47.8%) reported more than 4 pain episodes in the prior 12 months. The mean (SD) pain frequency and severity t scores for the sample were 48.6 (11.4) and 50.3 (10.1), respectively. Educational attainment and income were not associated with increased pain frequency or severity. Unemployment (β, 2.13; 95% CI, 0.99 to 3.23; P < .001) and female sex (β, 1.78; 95% CI, 0.80 to 2.76; P < .001) were associated with increased pain frequency. Age younger than 18 years was inversely associated with pain frequency (β, -5.72; 95% CI, -7.72 to -3.72; P < .001) and pain severity (β, 5.10; 95% CI, -6.70 to -3.51; P < .001). Depression was associated with increased pain frequency (β, 2.18; 95% CI, 1.04 to 3.31; P < .001) but not pain severity. Hydroxyurea use was associated with increased pain severity (β, 1.36; 95% CI, 0.47 to 2.24; P = .003), and daily use of pain medication was associated with both increased pain frequency (β, 6.29; 95% CI, 5.28 to 7.31; P < .001) and pain severity (β, 2.87; 95% CI, 1.95 to 3.80; P < .001). Conclusions and Relevance These findings suggest that employment status, sex, age, and depression are associated with pain frequency among patients with SCD. Depression screening for these patients is warranted, especially among those experiencing higher pain frequency and severity. Comprehensive treatment and pain reduction must consider the full experiences of patients with SCD, including impacts on mental health.
Collapse
Affiliation(s)
- Kelly M. Harris
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Surgery, Division of Public Health Sciences, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Liliana Preiss
- RTI International, Research Triangle Park, North Carolina
| | - Taniya Varughese
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Anna Bauer
- School of Medicine, University of Missouri at Columbia, Columbia
| | - Cecelia L. Calhoun
- Department of Pediatrics, Pediatric Hematology/Oncology, and Cancer Center, Hematology Program, Yale University School of Medicine, New Haven, Connecticut
| | - Marsha Treadwell
- School of Medicine, Department of Pediatrics, Division of Hematology, University of California, San Francisco
| | - Rita Masese
- School of Nursing, Duke University, Durham, North Carolina
| | - Jane S. Hankins
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Faiz Ahmed Hussain
- Department of Medicine, Division of Hematology and Oncology, College of Medicine, University of Illinois at Chicago, Chicago
| | - Jeffrey Glassberg
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cathy L. Melvin
- College of Medicine, Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Robert Gibson
- Department of Emergency Medicine, Augusta University, Medical College of Georgia, Augusta
| | - Allison A. King
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Surgery, Division of Public Health Sciences, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, St Louis Children’s Hospital, Washington University in St Louis, School of Medicine, St Louis, Missouri
| |
Collapse
|
14
|
Bhatt N, Calhoun C, Longoria J, Nwosu C, Howell KE, Varughese T, Kang G, Jacola L, Hankins JS, King A. Health literacy correlates with abbreviated full-scale IQ in adolescent and young adults with sickle cell disease. Pediatr Blood Cancer 2023; 70:e30281. [PMID: 36861391 PMCID: PMC10425156 DOI: 10.1002/pbc.30281] [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: 09/08/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a chronic condition with progressive neurocognitive deficits. Health literacy (HL) is essential during adolescence and young adulthood, as the transition to adult care requires healthcare decisions. HL is known to be low in SCD; however, relation between general cognitive ability and HL has not been investigated. METHODS This cross-sectional study included adolescent and yound adults (AYAs) with SCD from two institutions. Logistic regression measured the association between HL, measured by the Newest Vital Sign tool, and general cognitive ability, measured with abbreviated full-scale intelligence quotient (FSIQ) on the Wechsler Abbreviated Scale of Intelligence. RESULTS Our cohort contained 93 participants at two sites: 47 (51%) at Memphis, TN and 46 (49%) at St. Louis, MO, ranging from ages 15-45 years (mean = 21 years) and with a majority (70%) possessing a high school education or greater. Only 40/93 participants (43%) had adequate HL. Lower abbreviated FSIQ (p < .0001) and younger age at assessment (p = .0003) were associated with inadequate HL. For every standard score point increase in abbreviated FSIQ, the odds of having adequate HL compared to limited or possibly limited HL increase by 1.142 (95% confidence interval [CI]: 1.019-1.322) and 1.116 (95% CI: 1.045-1.209), respectively, after adjusting for age, institution, income, and educational attainment. CONCLUSIONS Understanding and addressing HL is imperative in improving self-management and health outcomes. Among AYA with SCD, low HL was prevalent and influenced by abbreviated FSIQ. Routine screening for neurocognitive deficits and HL should be performed to guide development of interventions to adapt to the HL of AYA with SCD.
Collapse
Affiliation(s)
- Nidhi Bhatt
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Cecelia Calhoun
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Chinonyelum Nwosu
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kristen E. Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Taniya Varughese
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lisa Jacola
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Allison King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
| |
Collapse
|
15
|
Ibemere SO, Oyedeji CI, Preiss L, Van Althuis LE, Hankins JS, Azul M, Burns EN, Glassberg J, Hagar W, Hussain F, King A, Melvin C, Myers J, Snyder A, Shah N, Tanabe P. Characterising the prevalence of overweight and obese status among adults with sickle cell disease. Br J Haematol 2023; 200:633-642. [PMID: 36382420 PMCID: PMC9957798 DOI: 10.1111/bjh.18548] [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: 08/25/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
Individuals with sickle cell disease (SCD) have historically been considered underweight. Despite increasing body mass index (BMI) in the general population, the prevalence of overweight and obese status remains unclear in the adult SCD population. Our primary aim was to determine the prevalence of overweight and obese status and to identify associations between BMI, demographic, and clinical characteristics. We conducted an analysis of abstracted electronic health record data and patient-reported outcomes from the Sickle Cell Disease Implementation Consortium registry; individuals aged 20-45 years were included. The median (interquartile range) BMI for the 1664 adults in this analysis was 23.9 (21.1-28) kg/m2 . In this cohort, 42.9% had a BMI of >25 kg/m2 (Centers for Disease Control and Prevention definition of overweight/obese). In multivariable analysis, higher odds of being overweight or obese were associated with female gender, older age, college education, private insurance, and hypertension diagnosis. Higher odds of a BMI of >25 kg/m2 were observed in individuals with HbSC or HbSβ+ thalassaemia regardless of hydroxycarbamide (hydroxyurea) exposure (odds ratio [OR] 3.4, p < 0.0001) and HbSS or HbSβ0 thalassaemia exposed to hydroxycarbamide (OR 1.6, p = 0.0003) compared to those with HbSS or HbSβ0 thalassaemia with no hydroxycarbamide exposure. These data highlight the importance of early identification, prevention, and intervention for increasing BMI to reduce obesity-related complications that may impact SCD-related complications.
Collapse
Affiliation(s)
| | - Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Jane S Hankins
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melissa Azul
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ebony N Burns
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Ward Hagar
- University of California San Francisco, San Francisco, California, USA
| | - Faiz Hussain
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Allison King
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Myers
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Nirmish Shah
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke University Hospital, Durham, North Carolina, USA
| | - Paula Tanabe
- Duke University School of Nursing and Medicine, Durham, North Carolina, USA
| |
Collapse
|
16
|
Knisely MR, Yang Q, Stauffer N, Kenney M, Ashley-Koch A, Myers J, Walker JKL, Tanabe PJ, Shah NR. Evaluating Associations between Average Pain Intensity and Genetic Variation in People with Sickle Cell Disease: An Exploratory Study. Pain Manag Nurs 2023; 24:12-18. [PMID: 36096903 PMCID: PMC9925395 DOI: 10.1016/j.pmn.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pain is one of the most common and deleterious symptoms experienced by individuals with sickle cell disease (SCD). There is a paucity of studies identifying potential genetic mechanisms of pain in this population. AIM Examine associations between 11 functional single nucleotide polymorphisms in 9 candidate genes with reports of average pain intensity in individuals with sickle cell disease. METHOD Cross-sectional analyses were performed on data and blood samples collected through the Duke SCD Implementation Consortium Registry. Participants were asked to rate their pain "on the average" using an 11-point numeric rating scale (0 = no pain; 10 = pain as bad as you can imagine). We genotyped 11 single nucleotide polymorphisms in 9 pain-related genes using TaqMan® Genotyping Assays. Associations between each polymorphism and reports of average pain were evaluated. RESULTS The 86 participants (mean age: 28.7 years; 64% female) included in this study reported moderate pain on average (Mean = 4, Standard Deviation = 2.4). ICAM1 rs1799969 was the only genetic polymorphism that was significantly associated with pain (p = .01). Individuals with one or more minor alleles had lower average pain (Mean = 1.25, Standard Deviation = 1.50) than individuals without a minor allele (Mean = 4.13, Standard Deviation = 2.25). The effect size for ICAM1 rs1799969 was 1.30, which is considered large. The effect sizes for all other single nucleotide polymorphisms ranged from small to medium (range: 0-0.3). CONCLUSIONS Our findings provide preliminary evidence that the minor allele in ICAM1 rs1799969 had protective effects against experiencing more severe pain in sickle cell disease.
Collapse
Affiliation(s)
| | - Qing Yang
- Duke University School of Nursing, Durham, North Carolina
| | - Nic Stauffer
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Martha Kenney
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Allison Ashley-Koch
- Departments of Medicine and Biostatistics and Bioinformatics, Duke Molecular Physiology Institute, Durham, North Carolina; Duke University School of Medicine, Durham, North Carolina
| | - John Myers
- Duke University School of Nursing, Durham, North Carolina
| | | | - Paula J Tanabe
- Duke University School of Nursing, Durham, North Carolina
| | - Nirmish R Shah
- Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
17
|
Hankins JS, Potter MB, Fernandez ME, Melvin C, DiMartino L, Jacobs SR, Bosworth HB, King AA, Simon J, Glassberg JA, Kutlar A, Gordeuk VR, Shah N, Baumann AA, Klesges LM. Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease. FRONTIERS IN HEALTH SERVICES 2023; 2:1024541. [PMID: 36925803 PMCID: PMC10012741 DOI: 10.3389/frhs.2022.1024541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/09/2022] [Indexed: 01/22/2023]
Abstract
Background Sickle Cell Disease (SCD) is a progressive genetic disease that causes organ damage and reduces longevity. Hydroxyurea is an underutilized evidence-based medication that reduces complications and improves survival in SCD. In a multi-site clinical trial, part of the NIH-funded Sickle Cell Disease Implementation Consortium (SCDIC), we evaluate the implementation of a multi-level and multi-component mobile health (mHealth) patient and provider intervention to target the determinants and context of low hydroxyurea use. Given the complexity of the intervention and contextual variability in its implementation, we combined different behavioral and implementation theories, models, and frameworks to facilitate the evaluation of the intervention implementation. In this report, we describe engagement with stakeholders, planning of the implementation process, and final analytical plan to evaluate the implementation outcomes. Methods During 19 meetings, a 16-member multidisciplinary SCDIC implementation team created, conceived, and implemented a project that utilized Intervention Mapping to guide designing an intervention and its evaluation plan. The process included five steps: (1) needs assessment of low hydroxyurea utilization, (2) conceptual framework development, (3) intervention design process, (4) selection of models and frameworks, and (5) designing evaluation of the intervention implementation. Results Behavioral theories guided the needs assessment and the design of the multi-level mHealth intervention. In designing the evaluation approach, we combined two implementation frameworks to best account for the contextual complexity at the organizational, provider, and patient levels: (1) the Consolidated Framework for Implementation Research (CFIR) that details barriers and facilitators to implementing the mHealth intervention at multiple levels (users, organization, intervention characteristics, broader community), and (2) the Technology Acceptance Model (TAM), a conceptual model specific for explaining the intent to use new information technology (including mHealth). The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework was used to measure the outcomes. Discussion Our research project can serve as a case study of a potential approach to combining different models/frameworks to help organize and plan the evaluation of interventions to increase medication adherence. The description of our process may serve as a blueprint for future studies developing and testing new strategies to foster evidence-based treatments for individuals living with SCD.
Collapse
Affiliation(s)
- J. S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - M. B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA, United States
- Clinical, Family, and Community Medicine, University of California San Francisco, CA, United States
| | - M. E Fernandez
- Health Promotion and Behavioral Sciences, University of Texas Health Science Center, School of Public Health at Houston, Houston, TX, United States
| | - C Melvin
- The Medical University of South Carolina, Charleston, SC, United States
| | - L DiMartino
- RTI International, Research triangle park, NC, United States
| | - S. R Jacobs
- RTI International, Research triangle park, NC, United States
| | - H. B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - A. A King
- Department of Pediatrics, Washington University, Saint louis, MO, United States
| | - J Simon
- Department of Emergency Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - J. A Glassberg
- Department of Emergency Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - A Kutlar
- Augusta University, Augusta, GA, United States
| | - V. R Gordeuk
- Department of Medicine, the University of Illinois at Chicago, Chicago, IL, United States
| | - N Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC, United States
| | - A. A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint louis, MO, United States
| | - L. M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint louis, MO, United States
| | | |
Collapse
|
18
|
Ferreira de Matos C, Comont T, Castex MP, Lafaurie M, Walter O, Moulis G, Dion J, Cougoul P. Risk of vaso-occlusive episodes in patients with sickle cell disease exposed to systemic corticosteroids: a comprehensive review. Expert Rev Hematol 2022; 15:1045-1054. [PMID: 36412212 DOI: 10.1080/17474086.2022.2149488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most frequent inherited disorder in the world. It is caused by a single amino acid mutation on the beta-globin chain, which lead to red blood cell deformation, haemolysis, and chronic inflammation. Clinical consequences are vaso-occlusives crisis, acute chest syndrome, thrombosis, infection, and chronic endothelial injury. AREAS COVERED Corticosteroids are an old therapeutic class, that are inexpensive and widely available, which can be administered in different forms. Their adverse effects are numerous and well-known. This class could appear to be useful in SCD treatment due to its anti-inflammatory effect. Moreover, corticosteroids remain an essential therapeutic class for many indications, besides SCD. Although specific adverse effects of corticosteroids have been suspected in SCD patients for decades, recent papers has reported strong evidence of specific and severe adverse effects in this population. Based on a literature review, we will discuss pathophysiological considerations, consequences, and practical use of corticosteroids in SCD. EXPERT OPINION High corticosteroid doses, for any indication , induce vaso-occlusive crises, acute chest syndrome, and re-hospitalization in patients with SCD. There is no evidence of any benefits of corticosteroid use in the SCD acute events. Prevention by hydroxyurea and/or red blood cell transfusion or exchange should be discussed when corticosteroid use is indispensable.
Collapse
Affiliation(s)
| | - Thibault Comont
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France
| | - Marie-Pierre Castex
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital - Toulouse University Hospital, Toulouse, France
| | - Margaux Lafaurie
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), Toulouse, France.,Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Ondine Walter
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France.,CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), Toulouse, France
| | - Guillaume Moulis
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France.,CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), Toulouse, France
| | - Jérémie Dion
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France
| | - Pierre Cougoul
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
19
|
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.
Collapse
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
| | | |
Collapse
|
20
|
Badawy SM, DiMartino L, Brambilla D, Klesges L, Baumann A, Burns E, DeMartino T, Jacobs S, Khan H, Nwosu C, Shah N, Hankins JS. Impact of the COVID-19 Pandemic on the Implementation of Mobile Health to Improve the Uptake of Hydroxyurea in Patients With Sickle Cell Disease: Mixed Methods Study. JMIR Form Res 2022; 6:e41415. [PMID: 36240004 PMCID: PMC9578525 DOI: 10.2196/41415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hydroxyurea therapy is effective for reducing complications related to sickle cell disease (SCD) and is recommended by National Health Lung and Blood Institute care guidelines. However, hydroxyurea is underutilized, and adherence is suboptimal. We wanted to test a multilevel mobile health (mHealth) intervention to increase hydroxyurea adherence among patients and improve prescribing among providers in a multicenter clinical trial. In the first 2 study sites, participants were exposed to the early phases of the COVID-19 pandemic, which included disruption to their regular SCD care. OBJECTIVE We aimed to describe the impact of the COVID-19 pandemic on the implementation of an mHealth behavioral intervention for improving hydroxyurea adherence among patients with SCD. METHODS The first 2 sites initiated enrollment 3 months prior to the start of the pandemic (November 2019 to March 2020). During implementation, site A clinics shut down for 2 months and site B clinics shut down for 9 months. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate the implementation and effectiveness of the intervention. mHealth implementation was assessed based on patients' daily app use. Adherence to hydroxyurea was calculated as the proportion of days covered (PDC) from prescription records over the first 12 and 24 weeks after implementation. A linear model examined the relationship between app usage and PDC change, adjusting for baseline PDC, lockdown duration, and site. We conducted semistructured interviews with patients, health care providers, administrators, and research staff to identify factors associated with mHealth implementation and effectiveness. We used a mixed methods approach to investigate the convergence of qualitative and quantitative findings. RESULTS The percentage of patients accessing the app decreased after March 15, 2020 from 86% (n=55) to 70% (n=45). The overall mean PDC increase from baseline to week 12 was 4.5% (P=.32) and to week 24 was 1.5% (P=.70). The mean PDC change was greater at site A (12 weeks: 20.9%; P=.003; 24 weeks: 16.7%; P=.01) than site B (12 weeks: -8.2%; P=.14; 24 weeks: -10.3%; P=.02). After adjustment, PDC change was 13.8% greater in those with increased app use after March 15, 2020. Interview findings indicated that site B's closure during COVID-19 had a greater impact, but almost all patients reported that the InCharge Health app helped support more consistent medication use. CONCLUSIONS We found significant impacts of the early clinic lockdowns, which reduced implementation of the mHealth intervention and led to reduced patient adherence to hydroxyurea. However, disruptions were lower among participants who experienced shorter clinic lockdowns and were associated with higher hydroxyurea adherence. Investigation of added strategies to mitigate the effects of care interruptions during major emergencies (eg, patient coaching and health navigation) may "insulate" the implementation of interventions to increase medication adherence. TRIAL REGISTRATION ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/16319.
Collapse
Affiliation(s)
- Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School Medicine, Chicago, IL, United States
| | - Lisa DiMartino
- RTI International, Research Triangle Park, NC, United States
| | | | - Lisa Klesges
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Ana Baumann
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Ebony Burns
- Division of Hematology, Duke University School of Medicine, Durham, NC, United States
| | - Terri DeMartino
- Division of Hematology, Duke University School of Medicine, Durham, NC, United States
| | - Sara Jacobs
- RTI International, Research Triangle Park, NC, United States
| | - Hamda Khan
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Chinonyelum Nwosu
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Nirmish Shah
- Division of Hematology, Duke University School of Medicine, Durham, NC, United States
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
- University of Tennessee Health Science Center, Memphis, TN, United States
| |
Collapse
|
21
|
Treadwell MJ, Mushiana S, Badawy SM, Preiss L, King AA, Kroner B, Chen Y, Glassberg J, Gordeuk V, Shah N, Snyder A, Wun T. An evaluation of patient-reported outcomes in sickle cell disease within a conceptual model. Qual Life Res 2022; 31:2681-2694. [PMID: 35445915 PMCID: PMC9356962 DOI: 10.1007/s11136-022-03132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the relations between patient-reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 - 45 years enrolled in the multi-site Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD-related factors, particularly pain, and barriers to care would independently contribute to functioning as measured using PRO domains. METHODS Participants (N = 2054) completed a 48-item survey including socio-demographics and PRO measures, e.g., social functioning, pain impact, emotional distress, and cognitive functioning. Participants reported on lifetime SCD complications, pain episode frequency and severity, and barriers to healthcare. RESULTS Higher pain frequency was associated with higher odds of worse outcomes in all PRO domains, controlling for age, gender and site (OR range 1.02-1.10, 95% CI range [1.004-1.12]). Reported history of treatment for depression was associated with 5 of 7 PRO measures (OR range 1.58-3.28 95% CI range [1.18-4.32]). Fewer individual barriers to care and fewer SCD complications were associated with better outcomes in the emotion domain (OR range 0.46-0.64, 95% CI range [0.34-0.86]). CONCLUSIONS Study results highlight the importance of the biopsychosocial model to enhance understanding of the needs of this complex population, and to design multi-dimensional approaches for providing more effective interventions to improve outcomes.
Collapse
Affiliation(s)
- Marsha J Treadwell
- University of California San Francisco Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA.
| | | | - Sherif M Badawy
- Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Liliana Preiss
- Research Triangle International, Research Triangle Park, NC, USA
| | | | - Barbara Kroner
- Research Triangle International, Research Triangle Park, NC, USA
| | - Yumei Chen
- University of California San Francisco Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | | | | | | | | | - Theodore Wun
- University of California Davis, Sacramento, CA, USA
| |
Collapse
|
22
|
Calhoun C, Luo L, Baumann AA, Bauer A, Shen E, McKay V, Hooley C, James A, King AA. Transition for Adolescents and Young Adults With Sickle Cell Disease in a US Midwest Urban Center: A Multilevel Perspective on Barriers, Facilitators, and Future Directions. J Pediatr Hematol Oncol 2022; 44:e872-e880. [PMID: 35731941 PMCID: PMC9218344 DOI: 10.1097/mph.0000000000002322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sickle cell disease (SCD), an inherited red blood cell disorder, primarily affects African Americans in the United States. Adolescents and young adults with SCD (AYA-SCD) are at risk of high morbidity and mortality when transitioning from pediatric to adult care. The goal of this qualitative study was to understand factors associated with optimal implementation of the AYA-SCD transition. METHODS Participants were recruited from a large hospital system and the community. Interview guides included topics on access to primary and specialized care, beliefs and practices related to pain control, transition from pediatric to adult care, and patient experiences in the emergency department. Data were coded and analyzed using an inductive thematic coding approach in combination with a deductive coding approach using domains from the Consolidated Framework for Implementation Research (CFIR). RESULTS Fifty-nine participants, including 21 AYA-SCD from both the pediatric and adult clinics, 17 caregivers, 9 pediatric SCD providers, 6 adult SCD providers, and 6 emergency department providers, completed 11 focus groups and 5 semistructured interviews. Results identified multiple factors within the domains of CFIR including the outer setting, inner setting, individual characteristics, and intervention characteristics. Results were incorporated into a transition framework to inform local practice improvement. CONCLUSION Our study highlights the importance of multilevel barriers and facilitators for AYA-SCD transition from pediatric to adult care. Future studies could use implementation science frameworks to understand local context and identify strategies and intervention characteristics to improve transition programming. These efforts will ultimately reduce health disparities and ensure health equity.
Collapse
Affiliation(s)
- Cecelia Calhoun
- Department of Pediatrics, Washington University School of Medicine
| | - Lingzi Luo
- Program in Occupational Therapy, Washington University School of Medicine
| | - Ana A. Baumann
- Washington University in St. Louis, Brown School of Social Work
| | - Anna Bauer
- Program in Occupational Therapy, Washington University School of Medicine
| | - Evelyn Shen
- Program in Occupational Therapy, Washington University School of Medicine
| | - Virginia McKay
- Washington University in St. Louis, Brown School of Social Work
| | - Cole Hooley
- Washington University in St. Louis, Brown School of Social Work
| | - Aimee James
- Division of Public Health Sciences, Washington University School of Medicine
| | - Allison A. King
- Department of Pediatrics, Washington University School of Medicine
- Program in Occupational Therapy, Washington University School of Medicine
- Division of Public Health Sciences, Washington University School of Medicine
| |
Collapse
|
23
|
Kroner BL, Hankins JS, Pugh N, Kutlar A, King AA, Shah NR, Kanter J, Glassberg J, Treadwell M, Gordeuk VR. Pregnancy outcomes with hydroxyurea use in women with sickle cell disease. Am J Hematol 2022; 97:603-612. [PMID: 35142007 PMCID: PMC8986611 DOI: 10.1002/ajh.26495] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/07/2022]
Abstract
Hydroxyurea reduces pain crises, acute chest syndrome, and blood transfusions in sickle cell disease (SCD), but potential detrimental effects on fertility and birth outcomes impede its use. Data on the effects of hydroxyurea taken for SCD during conception and pregnancy are scarce. The Sickle Cell Disease Implementation Consortium collected self-reported pregnancy history, corresponding hydroxyurea use, and pregnancy outcomes in women with SCD in the clinical setting. Among 1285 women 18-45 years of age, 737 (57.4%) reported 1788 pregnancies (1079 live births, 394 miscarriages, 40 stillbirths, 207 abortions, 48 current pregnancies, and 20 missing outcomes) of which 241 (15.9%) live births, miscarriages or stillbirths were conceived while on hydroxyurea. In univariate analyses, pregnancy number more than three, severe sickle genotype, history of stillbirth or miscarriage, and chronic kidney disease at enrollment were covariates significantly associated with a pregnancy ending in miscarriage or stillbirth. After adjustment for covariates and additional SCD severity markers in multivariate analyses, hydroxyurea use during conception and pregnancy, but not during conception only, was associated with an increase in the odds ratio (OR) of miscarriage or stillbirth (OR 2.21, 95% confidence interval [CI] 1.40-3.47). In analyses of live birth outcomes, hydroxyurea use during conception and pregnancy was associated with birth weight < 5.5 pounds in full-term infants (OR 2.98, 95% CI 1.09-7.38) but not with prematurity or serious medical problems at birth. These findings suggest that hydroxyurea use may be safe up to the time of conception, but that clinicians should continue to advise caution regarding use during pregnancy.
Collapse
Affiliation(s)
- Barbara L. Kroner
- Division of Biostatistics and Epidemiology RTI International Research Triangle Park North Carolina USA
| | - Jane S. Hankins
- Department of Hematology St. Jude Children's Research Hospital Memphis Tennessee USA
| | - Norma Pugh
- Division of Biostatistics and Epidemiology RTI International Research Triangle Park North Carolina USA
| | | | - Allison A. King
- Division of Hematology and Oncology Washington University School of Medicine St. Louis Missouri USA
| | - Nirmish R. Shah
- Pediatric Hematology/Oncology Duke University Durham North Carolina USA
| | - Julie Kanter
- Department of Medicine University of Alabama Birmingham Alabama USA
| | - Jeffrey Glassberg
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Marsha Treadwell
- Department of Hematology/Oncology UCSF Benioff Children's Hospital Oakland Oakland California USA
| | - Victor R. Gordeuk
- Department of Medicine University of Illinois at Chicago Chicago Illinois USA
| | | |
Collapse
|
24
|
Phillips S, Chen Y, Masese R, Noisette L, Jordan K, Jacobs S, Hsu LL, Melvin CL, Treadwell M, Shah N, Tanabe P, Kanter J. Perspectives of individuals with sickle cell disease on barriers to care. PLoS One 2022; 17:e0265342. [PMID: 35320302 PMCID: PMC8942270 DOI: 10.1371/journal.pone.0265342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited hemoglobinopathy that predominantly affects African Americans in the United States. The disease is associated with complications leading to high healthcare utilization rates, including emergency department (ED) visits and hospitalizations. Optimal SCD care requires a multidisciplinary approach involving SCD specialists to ensure preventive care, minimize complications and prevent unnecessary ED visits and hospitalizations. However, most individuals with SCD receive sub-optimal care or are unaffiliated with care (have not seen an SCD specialist). We aimed to identify barriers to care from the perspective of individuals with SCD in a multi-state sample. METHODS We performed a multiple methods study consisting of surveys and interviews in three comprehensive SCD centers from March to June 2018. Interviews were transcribed and coded, exploring themes around barriers to care. Survey questions on the specific themes identified in the interviews were analyzed using summary statistics. RESULTS We administered surveys to 208 individuals and conducted 44 in-depth interviews. Barriers to care were identified and classified according to ecological level (i.e., individual, family/interpersonal, provider, and socio-environmental/organizational level). Individual-level barriers included lack of knowledge in self-management and disease severity. Family/interpersonal level barriers were inadequate caregiver support and competing life demands. Provider level barriers were limited provider knowledge, provider inexperience, poor provider-patient relationship, being treated differently, and the provider's lack of appreciation of the patient's SCD knowledge. Socio-environmental/organizational level barriers included limited transportation, lack of insurance, administrative barriers, poor care coordination, and reduced access to care due to limited clinic availability, services provided or clinic refusal to provide SCD care. CONCLUSION Participants reported several multilevel barriers to SCD care. Strategies tailored towards reducing these barriers are warranted. Our findings may also inform interventions aiming to locate and link unaffiliated individuals to care.
Collapse
Affiliation(s)
- Shannon Phillips
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America
| | - Yumei Chen
- Department of Hematology/Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Rita Masese
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Laurence Noisette
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States of America
| | - Kasey Jordan
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America
| | - Sara Jacobs
- Translational Health Research Division, RTI International, Research Triangle Park, NC, United States of America
| | - Lewis L. Hsu
- Department of Pediatrics, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Cathy L. Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Marsha Treadwell
- Department of Pediatrics/Division of Hematology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Nirmish Shah
- School of Medicine, Duke University, Durham, NC, United States of America
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| |
Collapse
|
25
|
Knisely MR, Tanabe PJ, Walker JKL, Yang Q, Shah NR. Severe Persistent Pain and Inflammatory Biomarkers in Sickle Cell Disease: An Exploratory Study. Biol Res Nurs 2022; 24:24-30. [PMID: 34189962 PMCID: PMC9248289 DOI: 10.1177/10998004211027220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Severe pain is among the most common and deleterious symptoms experienced by individuals with sickle cell disease (SCD), of whom more than 50% report chronic pain. Despite this, the understanding of the biological contributors to persistent severe SCD pain is limited. This exploratory study sought to describe pain phenotypes based on frequency of severe pain experienced over 6 months and identify inflammatory biomarkers associated with pain phenotypes among individuals with SCD. METHODS This study used self-report and electronic health record data collected from 74 individuals enrolled in the Duke Sickle Cell Disease Implementation Consortium Registry. Plasma from previously collected blood specimens was used to generate inflammatory biomarker data using the Inflammation 20-plex ProcartaPlexTM panel. Descriptive statistics were used to describe the occurrence of severe pain over the past 6 months, and bi-variate analyses were used to evaluate the relationship between inflammatory biomarkers and pain phenotypes. RESULTS Among the 74 participants included in this study, 33.8% reported severe pain occurring never or rarely, 40.5% reported severe pain occurring sometimes, and 25.7% reported severe pain occurring often or always. Soluble E-selectin (sE-selectin) was the only inflammatory biomarker significantly associated with the pain phenotype groups (p = 0.049). Post hoc comparisons identified that participants in the often/always severe pain group had significantly higher plasma concentrations of sE-selectin compared to those in the sometimes severe pain group (p = 0.040). CONCLUSIONS Our findings provide preliminary evidence of the frequent occurrence of severe pain and that sE-selectin may be an objective biomarker for the frequent occurrence of severe pain in this population.
Collapse
Affiliation(s)
| | | | | | - Qing Yang
- Duke University School of Nursing,
Durham, NC, USA
| | | |
Collapse
|
26
|
Paintsil V, Amuzu EX, Nyanor I, Asafo-Adjei E, Mohammed AR, Yawnumah SA, Oppong-Mensah YG, Nguah SB, Obeng P, Dogbe EE, Jonas M, Nembaware V, Mazandu G, Ohene-Frempong K, Wonkam A, Makani J, Ansong D, Osei-Akoto A. Establishing a Sickle Cell Disease Registry in Africa: Experience From the Sickle Pan-African Research Consortium, Kumasi-Ghana. Front Genet 2022; 13:802355. [PMID: 35281803 PMCID: PMC8908904 DOI: 10.3389/fgene.2022.802355] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) is the most common clinically significant hemoglobinopathy, characterized by painful episodes, anemia, high risk of infection, and other acute and chronic complications. In Africa, where the disease is most prevalent, large longitudinal data on patients and their outcomes are lacking. This article describes the experiences of the Kumasi Center for SCD at the Komfo Anokye Teaching Hospital (KCSCD-KATH), a Sickle Pan-African Research Consortium (SPARCO) site and a SickleInAfrica Consortium member, in establishing a SCD registry for the evaluation of the outcomes of patients. It also provides a report of a preliminary analysis of the data. The process of developing the registry database involved comprehensive review of the center's SCD patient medical records, incorporating data elements developed by the SickleInAfrica Consortium and obtaining ethical clearance from the local Institutional Review Board. From December 2017 to March 2020, 3,148 SCD patients were enrolled into the SCD registry. Enrollment was during the SCD outpatient clinic visits or through home visits. A significant proportion of the patients was from the newborn screening cohort (50.3%) and was males (52.9%). SCD-SS, SCD-SC, and Sβ +thalassemia were seen in 67.2, 32.5, and 0.3% patients, respectively. The majority of the patients were in a steady state at enrollment; however, some were enrolled after discharge for an acute illness admission. The top two clinical diagnoses for SCD-SS patients were sickle cell painful events and acute anemia secondary to hyperhemolysis with incidence rates of 141.86 per 10,000 person months of observation (PMO) and 32.74 per 10,000 PMO, respectively. In SCD-SC patients, the top two diagnoses were sickle cell painful events and avascular necrosis with incidence rates of 203.09 per 10,000 PMO and 21.19 per 10,000 PMO, respectively. The SPARCO Kumasi site has developed skills and infrastructure to design, manage, and analyze data in the SCD registry. The newborn screening program and alternative recruitment methods such as radio announcement and home visits for defaulting patients were the key steps taken in enrolling patients into the registry. The registry will provide longitudinal data that will help improve knowledge of SCD in Ghana and Africa through research.
Collapse
Affiliation(s)
- Vivian Paintsil
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Evans Xorse Amuzu
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Isaac Nyanor
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | | | - Samuel Blay Nguah
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Paul Obeng
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Elliot Eli Dogbe
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mario Jonas
- Department of Pathology, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria Nembaware
- Department of Pathology, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston Mazandu
- Department of Pathology, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Ambroise Wonkam
- Department of Pathology, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julie Makani
- SPARCo, Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar Es Salam, Tanzania
| | - Daniel Ansong
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Alex Osei-Akoto
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | | |
Collapse
|
27
|
Smeltzer MP, Howell KE, Treadwell M, Preiss L, King AA, Glassberg JA, Tanabe P, Badawy SM, DiMartino L, Gibson R, Kanter J, Klesges LM, Hankins JS. Identifying barriers to evidence-based care for sickle cell disease: results from the Sickle Cell Disease Implementation Consortium cross-sectional survey of healthcare providers in the USA. BMJ Open 2021; 11:e050880. [PMID: 34789492 PMCID: PMC8601067 DOI: 10.1136/bmjopen-2021-050880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Sickle cell disease (SCD) leads to chronic and acute complications that require specialised care to manage symptoms and optimise clinical results. The National Heart Lung and Blood Institute (NHLBI) evidence-based guidelines assist providers in caring for individuals with SCD, but adoption of these guidelines by providers has not been optimal. The objective of this study was to identify barriers to treating individuals with SCD. METHODS The SCD Implementation Consortium aimed to investigate the perception and level of comfort of providers regarding evidence-based care by surveying providers in the regions of six clinical centres across the USA, focusing on non-emergency care from the providers' perspective. RESULTS Respondents included 105 providers delivering clinical care for individuals with SCD. Areas of practice were most frequently paediatrics (24%) or haematology/SCD specialist (24%). The majority (77%) reported that they were comfortable managing acute pain episodes while 63% expressed comfort with managing chronic pain. Haematologists and SCD specialists showed higher comfort levels prescribing opioids (100% vs 67%, p=0.004) and managing care with hydroxyurea (90% vs 51%, p=0.005) compared with non-haematology providers. Approximately 33% of providers were unaware of the 2014 NHLBI guidelines. Nearly 63% of providers felt patients' medical needs were addressed while only 22% felt their mental health needs were met. CONCLUSIONS A substantial number of providers did not know about NHLBI's SCD care guidelines. Barriers to providing care for patients with SCD were influenced by providers' specialty, training and practice setting. Increasing provider knowledge could improve hydroxyurea utilisation, pain management and mental health support.
Collapse
Affiliation(s)
- Matthew P Smeltzer
- School of Public Health, The University of Memphis, Memphis, Tennessee, USA
| | - Kristen E Howell
- School of Public Health, The University of Memphis, Memphis, Tennessee, USA
| | - Marsha Treadwell
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Liliana Preiss
- RTI International, Research Triangle Park, Carolina, USA
| | - Allison A King
- Program in Occupational Therapy, Departments of Pediatrics, Medicine, and Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | | | - Paula Tanabe
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa DiMartino
- RTI International, Research Triangle Park, Carolina, USA
| | - Robert Gibson
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Julie Kanter
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Lisa M Klesges
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| |
Collapse
|
28
|
Hankins JS, Klesges LM. Bridging the implementation gap in medication adherence. If you build it, will they come? Br J Haematol 2021; 196:17-18. [PMID: 34786706 DOI: 10.1111/bjh.17953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - Lisa M Klesges
- Washington University in St Louis School of Medicine, St Louis, MO, USA
| |
Collapse
|
29
|
Masese RV, Bulgin D, Knisely MR, Preiss L, Stevenson E, Hankins JS, Treadwell MJ, King AA, Gordeuk VR, Kanter J, Gibson R, Glassberg JA, Tanabe P, Shah N. Sex-based differences in the manifestations and complications of sickle cell disease: Report from the Sickle Cell Disease Implementation Consortium. PLoS One 2021; 16:e0258638. [PMID: 34714833 PMCID: PMC8555833 DOI: 10.1371/journal.pone.0258638] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sex-based clinical outcome differences in sickle cell disease (SCD) remain largely unknown despite evidence that female sex is associated with an increased lifespan. To better characterize sex-based differences in SCD, we assessed pain, treatment characteristics, laboratory measures and complications among males and females currently enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. METHODS The SCDIC consists of eight comprehensive SCD centers and one data coordinating center that received funding from the National Heart Lung and Blood Institute to improve outcomes for individuals with SCD. Eligibility criteria included: 15 to 45 years of age and a confirmed diagnosis of SCD. Self-report surveys were completed and data were also abstracted from the participants' medical records. RESULTS A total of 2,124 participants were included (mean age: 27.8 years; 56% female). The majority had hemoglobin SS SCD genotype. Females had worse reports of pain severity (mean (SD) T-score 51.6 (9.6) vs 49.3 (10), p<0.001), more vaso-occlusive episodes (p = 0.01) and a higher occurrence of 3 or more hospital admissions in the past year (30.9% vs. 25.5, p = 0.03). On multivariable analysis, males had higher odds of acute chest syndrome (odds ratio (OR) 1.4, p = 0.002), cardiovascular (OR 1.70, p<0.001) and musculoskeletal (OR 1.33, p = 0.0034) complications and lower odds of depression (OR 0.77, p = 0.0381). Females had higher fetal hemoglobin levels with and without hydroxyurea use (9.6% vs 8.5%, p = 0.03 and 3% vs 2.2%, p = 0.0005, respectively). CONCLUSION Our data suggests that sex differences in clinical outcomes do occur among individuals with SCD. Future research needs to explore the mechanisms underlying these differences.
Collapse
Affiliation(s)
- Rita V. Masese
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Dominique Bulgin
- College of Nursing, University of Tennessee Knoxville, Knoxville, Tennessee, United States of America
| | - Mitchell R. Knisely
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Liliana Preiss
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Eleanor Stevenson
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Marsha J. Treadwell
- Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital, Oakland, California, United States of America
| | - Allison A. King
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Victor R. Gordeuk
- University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Julie Kanter
- University of Alabama, Birmingham, Alabama, United States of America
| | - Robert Gibson
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, United States of America
| | - Jeffrey A. Glassberg
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Nirmish Shah
- School of Nursing, Duke University, Durham, North Carolina, United States of America
- School of Medicine, Duke University, Durham, North Carolina, United States of America
| | | |
Collapse
|
30
|
Knisely MR, Tanabe PJ, Yang Q, Masese R, Jiang M, Shah NR. Severe Pain Profiles and Associated Sociodemographic and Clinical Characteristics in Individuals With Sickle Cell Disease. Clin J Pain 2021; 37:669-677. [PMID: 34265788 PMCID: PMC8373671 DOI: 10.1097/ajp.0000000000000957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify classes of individuals with sickle cell disease (SCD) who share distinct severe pain profiles and evaluate differences in demographic, clinical, and psychosocial characteristics between classes. METHODS This exploratory, cross-sectional study used data collected for the SCD Implementation Consortium Research Registry at Duke University. Using Adult Sickle Cell Quality of Life-Measurement System pain-item data from 291 adults with SCD, latent class analysis was used to determine classes of individuals sharing distinct severe pain profiles. Bivariate analyses and logistic regression models were used to assess the relationships between pain profile classes and demographic, clinical, and psychosocial characteristics. RESULTS Three classes sharing distinct severe pain profiles were identified: Low Frequency and Impact class (n=73), Moderate Frequency and Impact class (n=94), and High Frequency and Impact class (n=124). When compared with the Low Frequency and Impact class and controlling for age and sex, individuals in the Moderate Frequency and Impact class were more likely to: be female (P=0.031) and unemployed (P=0.013); report worse sleep (P=0.005) and social functioning (P=0.005); have less emotional distress (P=0.004); describe pain as "sore" (P=0.002); and have previous SCD-related lung complications (P=0.016). When compared with the Low Frequency and Impact class, individuals in the High Frequency and Impact class: had worse social functioning (P<0.001) and previous SCD-related lung complications (P=0.006); described pain as "sore" (P<0.001); and were taking pain medication daily for SCD (P=0.001). DISCUSSION Severe pain experiences in SCD are complex; however, there are subgroups of people who report similar experiences of severe pain.
Collapse
Affiliation(s)
| | - Paula J Tanabe
- Duke University School of Nursing
- Duke University School of Medicine, Durham, NC
| | | | | | - Meilin Jiang
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Nirmish R Shah
- Duke University School of Nursing
- Duke University School of Medicine, Durham, NC
| |
Collapse
|
31
|
Masese RV, Crego N, Douglas C, Rains G, Bonnabeau E, DeMartino T, Shah N, Tanabe P. A Needs Assessment of Persons With Sickle Cell Disease in a Major Medical Center in North Carolina. N C Med J 2021; 82:312-320. [PMID: 34544765 PMCID: PMC10564552 DOI: 10.18043/ncm.82.5.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a complex disease associated with many complications and a shortened lifespan. In 2016, the National Heart, Lung and Blood Institute funded 8 centers in the United States to form the Sickle Cell Disease Implementation Consortium, with the goal of improving SCD care. The aim of our study was to describe SCD self-efficacy, pain interference, and barriers to care from the perspective of persons with SCD in the North Carolina center.METHODS Persons with SCD, aged 15 and older were recruited from a large SCD center in North Carolina. Surveys, focus groups, and interviews were completed.RESULTS Fifty-one people completed a survey, and 14 people completed an interview or focus group. Barriers identified in the survey included self-care barriers, misconceptions related to hydroxyurea (an oral medication that reduces rates of pain crisis), limited provider knowledge, and stigma. Concerning self-efficacy, participants reported that they were able to manage their pain symptoms most of the time. Pain interfered most with the ability to participate in social and day-to-day activities.Common themes from the focus groups and interviews included misconceptions about hydroxyurea, pain, provider knowledge, stigma, co-management, transportation, and insurance. Recommendations to improve care included the use of case managers, utilization of treatment guidelines, individualized pain protocols, and effective co-management by providers.LIMITATIONS Participants were recruited from 1 SCD center and may not be representative of the entire SCD population in North Carolina.CONCLUSIONS Participants described many perceived barriers to care, and their responses suggest a need for improvements in patient hydroxyurea education, provider knowledge, and care coordination.
Collapse
Affiliation(s)
- Rita V Masese
- School of Nursing, Duke University, Durham, North Carolina.
| | - Nancy Crego
- School of Nursing, Duke University, Durham, North Carolina
| | | | - Gary Rains
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Nirmish Shah
- Duke University Medical Center, Duke Health, Durham, North Carolina
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, North Carolina
| |
Collapse
|
32
|
Phillips SM, Schlenz AM, Mueller M, Melvin CL, Adams RJ, Kanter J. Identified barriers and facilitators to stroke risk screening in children with sickle cell anemia: results from the DISPLACE consortium. Implement Sci Commun 2021; 2:87. [PMID: 34376249 PMCID: PMC8353775 DOI: 10.1186/s43058-021-00192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children with sickle cell anemia are at risk for stroke. Ischemic stroke risk can be identified among children ages 2–16 years with sickle cell anemia using transcranial Doppler ultrasound. Despite strong recommendations for transcranial Doppler screening in guidelines released by the National Heart, Lung, and Blood Institute, implementation of transcranial Doppler screening in sickle cell anemia remains suboptimal. The purpose of this study was to identify barriers and facilitators to transcranial Doppler screening in a large national consortium to inform subsequent implementation interventions. Methods A qualitative descriptive approach was used to conduct 52 semi-structured interviews with a sample of patients with sickle cell anemia, their parents or primary caregivers, and healthcare providers dispersed across the United States. Interviews took place from September 2018 through March 2019. Directed content analysis was conducted with an adapted version of the Multilevel Ecological Model of Health as an initial coding framework, completed July 2019. Frequency analysis was conducted to determine predominant barrier and facilitator themes. Results Fourteen barrier themes and 12 facilitator themes emerged representing all levels of the ecological framework. Two barrier themes (Logistical Difficulties and Competing Life Demands and Gaps in Scheduling and Coordination), and 5 facilitator themes (Coordination, Scheduling and Reminders; Education and Information; Provider and Staff Investment and Assistance; Positive Patient Experience; and Convenient Location) were predominant. Conclusions Barriers and facilitators to transcranial Doppler screening in children with sickle cell anemia are complex and occur across multiple ecological levels. One barrier theme and 3 facilitator themes were found to be optimal to address in subsequent implementation interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00192-z.
Collapse
Affiliation(s)
- Shannon M Phillips
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, USA.
| | - Alyssa M Schlenz
- Department of Pediatrics, Medical University of South Carolina, Charleston, USA.,Department of Pediatrics, University of Colorado School of Medicine, 1800 Grant St. Suite 800, Denver, CO, 80203, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL, 35294, USA
| |
Collapse
|
33
|
Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study. Blood Adv 2021; 4:4463-4473. [PMID: 32941646 DOI: 10.1182/bloodadvances.2020001701] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022] Open
Abstract
Hydroxyurea is an efficacious treatment for sickle cell disease (SCD), but adoption is low among individuals with SCD. The objective of this study was to examine barriers to patients' adherence to hydroxyurea use regimens by using the intentional and unintentional medication nonadherence framework. We interviewed individuals with SCD age 15 to 49.9 years who were participants in the Sickle Cell Disease Implementation Consortium (SCDIC) Needs Assessment. The intentional and unintentional medication nonadherence framework explains barriers to using hydroxyurea and adds granularity to the understanding of medication adherence barriers unique to the SCD population. In total, 90 semi-structured interviews were completed across 5 of the 8 SCDIC sites. Among interviewed participants, 57.8% (n = 52) were currently taking hydroxyurea, 28.9% (n = 26) were former hydroxyurea users at the time of the interview, and 13.3% (n = 12) had never used hydroxyurea but were familiar with the medication. Using a constructivist grounded theory approach, we discovered important themes that contributed to nonadherence to hydroxyurea, which were categorized under unintentional (eg, Forgetfulness, External Influencers) and intentional (Negative Perceptions of Hydroxyurea, Aversion to Taking Any Medications) nonadherence types. Participants more frequently endorsed adherence barriers that fell into the unintentional nonadherence type (70%) vs intentional nonadherence type (30%). Results from this study will help SCD health care providers understand patient choices and decisions as being either unintentional or intentional, guide tailored clinical discussions regarding hydroxyurea therapy, and develop specific, more nuanced interventions to address nonadherence factors.
Collapse
|
34
|
Luo L, King AA, Carroll Y, Baumann AA, Brambilla D, Carpenter CR, Colla J, Gibson RW, Gollan S, Hall G, Klesges L, Kutlar A, Lyon M, Melvin CL, Norell S, Mueller M, Potter MB, Richesson R, Richardson LD, Ryan G, Siewny L, Treadwell M, Zun L, Armstrong-Brown J, Cox L, Tanabe P. Electronic Health Record-Embedded Individualized Pain Plans for Emergency Department Treatment of Vaso-occlusive Episodes in Adults With Sickle Cell Disease: Protocol for a Preimplementation and Postimplementation Study. JMIR Res Protoc 2021; 10:e24818. [PMID: 33861209 PMCID: PMC8087964 DOI: 10.2196/24818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023] Open
Abstract
Background Individuals living with sickle cell disease often require aggressive treatment of pain associated with vaso-occlusive episodes in the emergency department. Frequently, pain relief is poor. The 2014 National Heart, Lung, and Blood Institute evidence-based guidelines recommended an individualized treatment and monitoring protocol to improve pain management of vaso-occlusive episodes. Objective This study will implement an electronic health record–embedded individualized pain plan with provider and patient access in the emergency departments of 8 US academic centers to improve pain treatment for adult patients with sickle cell disease. This study will assess the overall effects of electronic health record–embedded individualized pain plans on improving patient and provider outcomes associated with pain treatment in the emergency department setting and explore barriers and facilitators to the implementation process. Methods A preimplementation and postimplementation study is being conducted by all 8 sites that are members of the National Heart, Lung, and Blood Institute–funded Sickle Cell Disease Implementation Consortium. Adults with sickle cell disease aged 18 to 45 years who had a visit to a participating emergency department for vaso-occlusive episodes within 90 days prior to enrollment will be eligible for inclusion. Patients will be enrolled in the clinic or remotely. The target analytical sample size of this study is 160 patient participants (20 per site) who have had an emergency department visit for vaso-occlusive episode treatment at participating emergency departments during the study period. Each site is expected to enroll approximately 40 participants to reach the analytical sample size. The electronic health record–embedded individualized pain plans will be written by the patient’s sickle cell disease provider, and sites will work with the local informatics team to identify the best method to build the electronic health record–embedded individualized pain plan with patient and provider access. Each site will adopt required patient and provider implementation strategies and can choose to adopt optional strategies to improve the uptake and sustainability of the intervention. The study is informed by the Technology Acceptance Model 2 and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Provider and patient baseline survey, follow-up survey within 96 hours of an emergency department vaso-occlusive episode visit, and selected qualitative interviews within 2 weeks of an emergency department visit will be performed to assess the primary outcome, patient-perceived quality of emergency department pain treatment, and additional implementation and intervention outcomes. Electronic health record data will be used to analyze individualized pain plan adherence and additional secondary outcomes, such as hospital admission and readmission rates. Results The study is currently enrolling study participants. The active implementation period is 18 months. Conclusions This study proposes a structured, framework-informed approach to implement electronic health record–embedded individualized pain plans with both patient and provider access in routine emergency department practice. The results of the study will inform the implementation of electronic health record–embedded individualized pain plans at a larger scale outside of Sickle Cell Disease Implementation Consortium centers. Trial Registration ClinicalTrials.gov NCT04584528; https://clinicaltrials.gov/ct2/show/NCT04584528. International Registered Report Identifier (IRRID) DERR1-10.2196/24818
Collapse
Affiliation(s)
- Lingzi Luo
- Washington University School of Medicine, St Louis, MO, United States
| | - Allison A King
- Washington University School of Medicine, St Louis, MO, United States
| | - Yvonne Carroll
- St Jude Children's Research Hospital, Memphis, TN, United States
| | - Ana A Baumann
- Washington University in St. Louis, St Louis, MO, United States
| | | | | | - Joseph Colla
- University of Illinois Chicago, Chicago, IL, United States
| | | | | | - Greg Hall
- Medical University of South Carolina, Charleston, SC, United States
| | - Lisa Klesges
- Washington University School of Medicine, St Louis, MO, United States.,University of Memphis, Memphis, TN, United States
| | | | | | - Cathy L Melvin
- Medical University of South Carolina, Charleston, SC, United States
| | - Sarah Norell
- University of Illinois Chicago, Chicago, IL, United States
| | - Martina Mueller
- Medical University of South Carolina, Charleston, SC, United States
| | - Michael B Potter
- University of California San Francisco, San Francisco, CA, United States
| | | | | | - Gery Ryan
- The RAND Corporation, Santa Monica, CA, United States
| | | | - Marsha Treadwell
- University of California San Francisco, San Francisco, CA, United States
| | - Leslie Zun
- Chicago Medical School, North Chicago, IL, United States
| | | | - Lisa Cox
- RTI International, Durham, NC, United States
| | | |
Collapse
|
35
|
Gyamfi J, Ojo T, Epou S, Diawara A, Dike L, Adenikinju D, Enechukwu S, Vieira D, Nnodu O, Ogedegbe G, Peprah E. Evidence-based interventions implemented in low-and middle-income countries for sickle cell disease management: A systematic review of randomized controlled trials. PLoS One 2021; 16:e0246700. [PMID: 33596221 PMCID: PMC7888630 DOI: 10.1371/journal.pone.0246700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite ~90% of sickle cell disease (SCD) occurring in low-and middle-income countries (LMICs), the vast majority of people are not receiving evidence-based interventions (EBIs) to reduce SCD-related adverse outcomes and mortality, and data on implementation research outcomes (IROs) and SCD is limited. This study aims to synthesize available data on EBIs for SCD and assess IROs. METHODS We conducted a systematic review of RCTs reporting on EBIs for SCD management implemented in LMICs. We identified articles from PubMed/Medline, Global Health, PubMed Central, Embase, Web of Science medical subject heading (MeSH and Emtree) and keywords, published from inception through February 23, 2020, and conducted an updated search through December 24, 2020. We provide intervention characteristics for each study, EBI impact on SCD, and evidence of reporting on IROs. MAIN RESULTS 29 RCTs were analyzed. EBIs identified included disease modifying agents, supportive care agents/analgesics, anti-malarials, systemic treatments, patient/ provider education, and nutritional supplements. Studies using disease modifying agents, nutritional supplements, and anti-malarials reported improvements in pain crisis, hospitalization, children's growth and reduction in severity and prevalence of malaria. Two studies reported on the sustainability of supplementary arginine, citrulline, and daily chloroquine and hydroxyurea for SCD patients. Only 13 studies (44.8%) provided descriptions that captured at least three of the eight IROs. There was limited reporting of acceptability, feasibility, fidelity, cost and sustainability. CONCLUSION EBIs are effective for SCD management in LMICs; however, measurement of IROs is scarce. Future research should focus on penetration of EBIs to inform evidence-based practice and sustainability in the context of LMICs. CLINICAL TRIAL REGISTRATION This review is registered in PROSPERO #CRD42020167289.
Collapse
Affiliation(s)
- Joyce Gyamfi
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Temitope Ojo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, United States of America
| | - Sabrina Epou
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Amy Diawara
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Lotanna Dike
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Deborah Adenikinju
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Scholastica Enechukwu
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Dorice Vieira
- New York University Health Sciences Library, New York, New York, United States of America
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Gbenga Ogedegbe
- Department of Population Health, New York University Medical Center, New York, New York, United States of America
| | - Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, United States of America
| |
Collapse
|
36
|
Linton EA, Goodin DA, Hankins JS, Kanter J, Preiss L, Simon J, Souffront K, Tanabe P, Gibson R, Hsu LL, King A, Richardsona LD, Glassberg JA. A Survey-Based Needs Assessment of Barriers to Optimal Sickle Cell Disease Care in the Emergency Department. Ann Emerg Med 2020; 76:S64-S72. [PMID: 32928465 DOI: 10.1016/j.annemergmed.2020.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Guided by an implementation science framework, this needs assessment identifies institutional-, provider-, and patient-level barriers to care of sickle cell disease (SCD) in the emergency department (ED) to inform future interventions conducted by the multicenter Sickle Cell Disease Implementation Consortium. METHODS The consortium developed and implemented a validated needs assessment survey administered to a cross-sectional convenience sample of patients with SCD and ED providers caring for them. In total, 516 adolescents and adults with SCD and 243 ED providers from 7 and 5 regions of the United States, respectively, responded to the ED care delivery for SCD survey. RESULTS Survey results demonstrated that 84.5% of respondents with SCD have an outpatient provider who treats many patients with SCD. In the ED, 54.3% reported not receiving care fast enough and 46.0% believed physicians did not care about them and believed similarly of nurses (34.9%). Consequently, 48.6% of respondents were "never" or "sometimes" satisfied with their ED care. Of surveyed ED providers, 75.1% were unaware of the National Heart, Lung, and Blood Institute recommendations for vaso-occlusive crises, yet 98.1% were confident in their knowledge about caring for patients with SCD. ED providers identified the following factors as barriers to care administration: opioid epidemic (62.1%), patient behavior (60.9%), crowding (58.0%), concern about addiction (47.3%), and implicit bias (37.0%). CONCLUSION The results underscore that many patients with SCD are dissatisfied with their ED care and highlight challenges to optimal care on the practice, provider, and patient levels. Exploring these differences may facilitate improvements in ED care.
Collapse
Affiliation(s)
- Elizabeth A Linton
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dania A Goodin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN
| | - Julie Kanter
- Division of Hematology and Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | - Jena Simon
- Department of Nursing, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kimberly Souffront
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Center for Nursing Research and Innovation, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Robert Gibson
- Department of Emergency Medicine, Medical College of Georgia, Augusta, GA
| | - Lewis L Hsu
- Division of Pediatric Hematology-Oncology, University of Illinois, Chicago, IL
| | - Allison King
- Department of Pediatric Hematology and Oncology, Washington University in St. Louis, St. Louis, MO
| | - Lynne D Richardsona
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
37
|
Masese RV, DeMartino T, Bonnabeau E, Burns EN, Preiss L, Varughese T, Nocek JM, Lasley P, Chen Y, Davila C, Nwosu C, Scott S, Bowman L, Gordon L, Clesca C, Peters-Lawrence M, Melvin C, Shah N, Tanabe P. Effective Recruitment Strategies for a Sickle Cell Patient Registry Across Sites from the Sickle Cell Disease Implementation Consortium (SCDIC). J Immigr Minor Health 2020; 23:725-732. [PMID: 33034793 PMCID: PMC8032811 DOI: 10.1007/s10903-020-01102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/27/2022]
Abstract
Sickle cell disease (SCD) is a genetic disorder predominantly affecting people of African descent and is associated with significant morbidity and mortality. To improve SCD outcomes, the National Heart Lung and Blood Institute funded eight centers to participate in the SCD Implementation Consortium. Sites were required to each recruit 300 individuals with SCD, over 20 months. We aim to describe recruitment strategies and challenges encountered. Participants aged 15-45 years with confirmed diagnosis of SCD were eligible. Descriptive statistics were used to analyze the effectiveness of each recruitment strategy. A total of 2432 participants were recruited. Majority (95.3%) were African American. Successful strategies were recruitment from clinics (68.1%) and affiliated sites (15.6%). Recruitment at community events, emergency departments and pain centers had the lowest yield. Challenges included saturation of strategies and time constraints. Effective recruitment of participants in multi-site studies requires multiple strategies to achieve adequate sample sizes.
Collapse
Affiliation(s)
- Rita V Masese
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA.
| | - Terri DeMartino
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Emily Bonnabeau
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Ebony N Burns
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | | | - Taniya Varughese
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Judith M Nocek
- Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Yumei Chen
- University of California, San Francisco, Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | | | | | - Samantha Scott
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Latanya Bowman
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Lauren Gordon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Cindy Clesca
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marlene Peters-Lawrence
- Division of Blood Diseases and Resources, National Institute of Health, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, USA
| | - Nirmish Shah
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Paula Tanabe
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | | |
Collapse
|
38
|
Knisely MR, Pugh N, Kroner B, Masese R, Gordeuk V, King AA, Smith SM, Gurney JG, Adams R, Wun T, Snyder A, Glassberg J, Shah N, Treadwell M. Patient-reported outcomes in sickle cell disease and association with clinical and psychosocial factors: Report from the sickle cell disease implementation consortium. Am J Hematol 2020; 95:1066-1074. [PMID: 32449965 DOI: 10.1002/ajh.25880] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 02/06/2023]
Abstract
Understanding patient experiences, quality of life, and treatment needs in individuals with sickle cell disease (SCD) is essential in promoting health and well-being. We used measures from the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me), Patient Reported Outcomes Measurement Information System (PROMIS), and Quality of Life in Neurological Disorders (NeuroQol) to evaluate pain impact, sleep impact, social functioning, depressive symptoms, tiredness, and cognitive function (collectively, patient reported outcomes [PROs]) and to identify associated demographic and clinical characteristics. Participants (n = 2201) between 18 and 45 years were recruited through the eight Sickle Cell Disease Implementation Consortium (SCDIC) sites. In multivariate models, PROs were significantly associated with one another. Pain impact was associated with age, education, employment, time since last pain attack, hydroxyurea use, opioid use, sleep impact, social functioning, and cognitive function (F = 88.74, P < .0001). Sleep impact was associated with household income, opioid use, pain impact, social functioning, depressive symptoms, and tiredness (F = 101.40, P < .0001). Social functioning was associated with employment, pain attacks in the past year, autoimmune/inflammatory comorbidities, pain impact, sleep impact, depressive symptoms, tiredness, and cognitive function (F = 121.73, P < .0001). Depressive symptoms were associated with sex, sleep impact, social functioning, tiredness, and cognitive function (F = 239.51, P < .0001). Tiredness was associated with sex, education, sleep impact, social functioning, depressive symptoms, and cognitive function (F = 129.13, P < .0001). These findings reflect the baseline PRO assessments among SCDIC registry participants. Further research is needed to better understand these outcomes and new targets for interventions to improve quality of life and function in people with SCD.
Collapse
Affiliation(s)
- Mitchell R. Knisely
- Department of Medicine, School of Nursing Duke University Durham North Carolina
| | | | | | - Rita Masese
- Department of Medicine, School of Nursing Duke University Durham North Carolina
| | - Victor Gordeuk
- Department of Medicine University of Illinois at Chicago Chicago Illinois
| | - Allison A. King
- Program in Occupational Therapy and Pediatrics, Division of Hematology and Oncology Washington University School of Medicine St. Louis Missouri
| | | | - James G. Gurney
- Division of Epidemiology, Biostatistics and Environmental Health University of Memphis Memphis Tennessee
| | - Robert Adams
- Department of Neurology Medical University of South Carolina Charleston South Carolina
| | - Ted Wun
- Division of Hematology and Oncology University of California Davis School of Medicine Sacramento California
| | - Angela Snyder
- Department of Public Management and Policy Georgia State University Atlanta Georgia
| | - Jeffrey Glassberg
- Department of Emergency Medicine Icahn School of Medicine at Mt. Sinai New York New York
| | - Nirmish Shah
- Department of Medicine, School of Nursing Duke University Durham North Carolina
| | - Marsha Treadwell
- University of California San Francisco Benioff Children's Hospital Oakland Oakland California
| | | |
Collapse
|
39
|
Hankins JS, Shah N, DiMartino L, Brambilla D, Fernandez ME, Gibson RW, Gordeuk VR, Lottenberg R, Kutlar A, Melvin C, Simon J, Wun T, Treadwell M, Calhoun C, Baumann A, Potter MB, Klesges L, Bosworth H. Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization: Protocol for an Efficacy and Implementation Study. JMIR Res Protoc 2020; 9:e16319. [PMID: 32442144 PMCID: PMC7388044 DOI: 10.2196/16319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hydroxyurea prevents disease complications among patients with sickle cell disease (SCD). Although its efficacy has been endorsed by the National Health Lung and Blood Institute evidence-based guidelines, its adoption is low, both by patients with SCD and providers. Mobile health (mHealth) apps provide benefits in improving medication adherence and self-efficacy among patients with chronic diseases and have facilitated prescription among medical providers. However, mHealth has not been systematically tested as a tool to increase hydroxyurea adherence nor has the combination of mHealth been assessed at both patient and provider levels to increase hydroxyurea utilization. OBJECTIVE This study aims to increase hydroxyurea utilization through a combined two-level mHealth intervention for both patients with SCD and their providers with the goals of increasing adherence to hydroxyurea among patients and improve hydroxyurea prescribing behavior among providers. METHODS We will test the efficacy of 2 mHealth interventions to increase both patient and provider utilization and knowledge of hydroxyurea in 8 clinical sites of the NHLBI-funded Sickle Cell Disease Implementation Consortium (SCDIC). The patient mHealth intervention, InCharge Health, includes multiple components that address memory, motivation, and knowledge barriers to hydroxyurea use. The provider mHealth intervention, Hydroxyurea Toolbox (HU Toolbox), addresses the clinical knowledge barriers in prescribing and monitoring hydroxyurea. The primary hypothesis is that among adolescents and adults with SCD, adherence to hydroxyurea, as measured by the proportion of days covered (the ratio of the number of days the patient is covered by the medication to the number of days in the treatment period), will increase by at least 20% after 24 weeks of receiving the InCharge Health app, compared with their adherence at baseline. As secondary objectives, we will (1) examine the change in health-related quality of life, acute disease complications, perceived health literacy, and perceived self-efficacy in taking hydroxyurea among patients who use InCharge Health and (2) examine potential increases in the awareness of hydroxyurea benefits and risks, appropriate prescribing, and perceived self-efficacy to correctly administer hydroxyurea therapy among SCD providers between baseline and 9 months of using the HU Toolbox app. We will measure the reach, adoption, implementation, and maintenance of both the InCharge Health and the HU Toolbox apps using the reach, effectiveness, adoption, implementation, and maintenance framework and qualitatively evaluate the implementation of both mHealth interventions. RESULTS The study is currently enrolling study participants. Recruitment is anticipated to be completed by mid-2021. CONCLUSIONS If this two-level intervention, that is, the combined use of InCharge Health and HU Toolbox apps, demonstrates efficacy in increasing adherence to hydroxyurea and prescribing behavior in patients with SCD and their providers, respectively, both apps will be offered to other institutions outside the SCDIC through a future large-scale implementation-effectiveness study. TRIAL REGISTRATION ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16319.
Collapse
Affiliation(s)
- Jane S Hankins
- St. Jude Childrens Research Hospital, Memphis, TN, United States
| | - Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, United States
| | - Lisa DiMartino
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Donald Brambilla
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Robert W Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Victor R Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Richard Lottenberg
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainsville, FL, United States
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Jena Simon
- Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - Ted Wun
- Division of Hematology Oncology, UC Davis School of Medicine, Davis, CA, United States
| | - Marsha Treadwell
- University of California San Francisco Benioff Children Hospital Oakland, Oakland, CA, United States
| | - Cecelia Calhoun
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Ana Baumann
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Michael B Potter
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Lisa Klesges
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Hayden Bosworth
- Department of Medicine, Duke University, Durham, NC, United States
| | -
- Bethesda, MA, United States
| |
Collapse
|
40
|
Glassberg JA, Linton EA, Burson K, Hendershot T, Telfair J, Kanter J, Gordeuk VR, King AA, Melvin CL, Shah N, Hankins JS, Epié AY, Richardson LD. Publication of data collection forms from NHLBI funded sickle cell disease implementation consortium (SCDIC) registry. Orphanet J Rare Dis 2020; 15:178. [PMID: 32635939 PMCID: PMC7341606 DOI: 10.1186/s13023-020-01457-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is an autosomal recessive blood disorder affecting approximately 100,000 Americans and 3.1 million people globally. The scarcity of relevant knowledge and experience with rare diseases creates a unique need for cooperation and infrastructure to overcome challenges in translating basic research advances into clinical advances. Despite registry initiatives in SCD, the unavailability of descriptions of the selection process and copies of final data collection tools, coupled with incomplete representation of the SCD population hampers further research progress. This manuscript describes the SCDIC (Sickle Cell Disease Implementation Consortium) Registry development and makes the SCDIC Registry baseline and first follow-up data collection forms available for other SCD research efforts. RESULTS Study data on 2400 enrolled patients across eight sites was stored and managed using Research Electronic Data Capture (REDCap). Standardized data collection instruments, recruitment and enrollment were refined through consensus of consortium sites. Data points included measures taken from a variety of validated sources (PHENX, PROMIS and others). Surveys were directly administered by research staff and longitudinal follow-up was coordinated through the DCC. Appended registry forms track medical records, event-related patient invalidation, pregnancy, lab reporting, cardiopulmonary and renal functions. CONCLUSIONS The SCDIC Registry strives to provide an accurate, updated characterization of the adult and adolescent SCD population as well as standardized, validated data collecting tools to guide evidence-based research and practice.
Collapse
Affiliation(s)
- Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA.
| | - Elizabeth A Linton
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Katrina Burson
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | - Joseph Telfair
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Victor R Gordeuk
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Allison A King
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Nirmish Shah
- Division of Hematology, Duke University School of Medicine, Durham, NC, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Axel Yannick Epié
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Lynne D Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| |
Collapse
|
41
|
Therrell BL, Lloyd-Puryear MA, Ohene-Frempong K, Ware RE, Padilla CD, Ambrose EE, Barkat A, Ghazal H, Kiyaga C, Mvalo T, Nnodu O, Ouldim K, Rahimy MC, Santos B, Tshilolo L, Yusuf C, Zarbalian G, Watson MS. Empowering newborn screening programs in African countries through establishment of an international collaborative effort. J Community Genet 2020; 11:253-268. [PMID: 32415570 PMCID: PMC7295888 DOI: 10.1007/s12687-020-00463-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023] Open
Abstract
In an effort to explore new knowledge and to develop meaningful collaborations for improving child health, the First Pan African Workshop on Newborn Screening was convened in June 2019 in Rabat, Morocco. Participants included an informal network of newborn screening stakeholders from across Africa and global experts in newborn screening and sickle cell disease. Over 150 attendees, representing 20 countries, were present including 11 African countries. The agenda focused on newborn screening rationale, techniques, system development, implementation barriers, ongoing research, and collaborations both globally and across Africa. We provide an overview of the workshop and a description of the newborn screening activities in the 11 African countries represented at the workshop, with a focus on sickle cell disease.
Collapse
Affiliation(s)
- Bradford L Therrell
- National Newborn Screening and Global Resource Center, University of Texas Health Science Center at San Antonio, Austin, TX, USA.
| | | | - Kwaku Ohene-Frempong
- Sickle Cell Foundation of Ghana, National Newborn Screening Program for Sickle Cell Disease, Accra, Ghana
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Emmanuela E Ambrose
- Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Amina Barkat
- Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Hassan Ghazal
- National Center for Scientific and Technological Research, Rabat, Morocco
| | - Charles Kiyaga
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Karim Ouldim
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fes, Morocco
| | - Mohamed Chérif Rahimy
- National Sickle Cell Disease Center, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Brígida Santos
- Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Léon Tshilolo
- Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Careema Yusuf
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Guisou Zarbalian
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Michael S Watson
- American College of Medical Genetics and Genomics, Bethesda, MD, USA
| |
Collapse
|
42
|
Baumann AA. Commentary: Adapting and Operationalizing the RE-AIM Framework for Implementation Science in Environmental Health: Clean Fuel Cooking Programs in Low Resource Countries. Front Public Health 2020; 8:218. [PMID: 32582613 PMCID: PMC7297202 DOI: 10.3389/fpubh.2020.00218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ana A. Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
43
|
Alberts NM, Badawy SM, Hodges J, Estepp JH, Nwosu C, Khan H, Smeltzer MP, Homayouni R, Norell S, Klesges L, Porter JS, Hankins JS. Development of the InCharge Health Mobile App to Improve Adherence to Hydroxyurea in Patients With Sickle Cell Disease: User-Centered Design Approach. JMIR Mhealth Uhealth 2020; 8:e14884. [PMID: 32383683 PMCID: PMC7245000 DOI: 10.2196/14884] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/31/2019] [Accepted: 01/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background Sickle cell disease (SCD) is an inherited blood disorder causing acute complications and chronic progressive end organ damage. SCD is associated with significant morbidity, early mortality, impaired health-related quality of life, and increased acute health care utilization. Hydroxyurea is a US Food and Drug Administration–approved medication that reduces disease complications, acute health care utilization, and costs. However, adherence to hydroxyurea is suboptimal. Mobile health (mHealth) interventions have the potential to improve hydroxyurea adherence, but few examples exist that are specific to the SCD population. Objective This study aimed to design a mHealth intervention for individuals with SCD to improve adherence to hydroxyurea, using a user-centered design that was informed by specific barriers to hydroxyurea adherence and utilization in this population. Methods This study consisted of 4 phases. In phase 1, individuals with SCD and health care providers participated in an optimization digital workshop. In phase 2, patients completed surveys pertaining to their interest in mHealth use, barriers and facilitators to hydroxyurea use, and health literacy. Phases 3 and 4 involved semistructured interviews and focus groups, respectively, and used the Health Belief Model (HBM) as the framework to investigate drivers of poor hydroxyurea adherence and to inform the development of an app prototype. In addition, in phase 4, we have incorporated the patients’ feedback on the preliminary app prototype and its features. Results Barriers to hydroxyurea adherence were consistent with the literature and included forgetfulness and several specific thoughts and emotions associated with hydroxyurea use (eg, fear of side effects, depression, stigma, and hopelessness). In addition, more than half of the participants reported potentially low health literacy. Preferred patient app features included 7 key components, namely (1) medication reminders and tracker, (2) disease education, (3) communication, (4) personalization, (5) motivation, (6) support during pain episodes, and (7) social support. Utilizing a user-centered design approach, data obtained from patients and providers were translated into features within the app, mapping to components of the HBM and the specific drivers of hydroxyurea adherence and matching the literacy level of the population, resulting in the development of a novel mobile app called InCharge Health. Conclusions The InCharge Health app is an mHealth intervention developed with substantial input from users and by mapping the HBM as the framework that guided the choice for its components. InCharge Health is a customized product for the SCD population aimed at optimizing medication adherence, with the end goal of improving quality of life and health outcomes among patients with SCD. The efficacy and implementation of the InCharge Health app as an mHealth intervention to promote hydroxyurea adherence will be tested in a future stepped-wedge multicenter trial for adolescents and adults with SCD.
Collapse
Affiliation(s)
- Nicole M Alberts
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jason Hodges
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Jeremie H Estepp
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Chinonyelum Nwosu
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States.,Methodist Health Care, Memphis, TN, United States
| | - Hamda Khan
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States.,Methodist Health Care, Memphis, TN, United States
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Ramin Homayouni
- Department of Foundational Medical Studies, William Beaumont School of Medicine, Oakland University, Rochester, MI, United States
| | - Sarah Norell
- University of Illinois Health, Institute for Healthcare Delivery Design, Chicago, IL, United States
| | - Lisa Klesges
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Jerlym S Porter
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States.,Methodist Health Care, Memphis, TN, United States
| |
Collapse
|
44
|
Kanter J, Gibson R, Lawrence RH, Smeltzer MP, Pugh NL, Glassberg J, Masese RV, King AA, Calhoun C, Hankins JS, Treadwell M. Perceptions of US Adolescents and Adults With Sickle Cell Disease on Their Quality of Care. JAMA Netw Open 2020; 3:e206016. [PMID: 32469413 PMCID: PMC7260622 DOI: 10.1001/jamanetworkopen.2020.6016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/22/2020] [Indexed: 12/19/2022] Open
Abstract
Importance Sickle cell disease (SCD) is the most common inherited red blood cell disorder in the United States, and previous studies have shown that individuals with SCD are affected by multiple health disparities, including stigmatization, inequities in funding, and worse health outcomes, which may preclude their ability to access quality health care. This needs assessment was performed as part of the Sickle Cell Disease Implementation Consortium (SCDIC) to assess barriers to care that may be faced by individuals with SCD. Objective To assess the SCD-related medical care experience of adolescents and adults with SCD. Design, Setting, and Participants This one-time survey study evaluated pain interference, quality of health care, and self-efficacy of 440 adults and adolescents (aged 15 to 50 years) with SCD of all genotypes and assessed how these variables were associated with their perceptions of outpatient and emergency department (ED) care. The surveys were administered once during office visits by trained study coordinators at 7 of 8 SCDIC sites in 2018. Results The SCDIC sites did not report the number of individuals approached to participate in this study; thus, a response rate could not be calculated. In addition, respondents were not required to answer every question in the survey; thus, the response rate per question differed for each variable. Of 440 individuals with SCD, participants were primarily female (245 [55.7%]) and African American (428 [97.3%]) individuals, with a mean (SD) age of 27.8 (8.6) years. The majority of participants (306 of 435 [70.3%]) had hemoglobin SS or hemoglobin S β0-thalassemia. Most respondents (361 of 437 [82.6%]) reported access to nonacute (usual) SCD care, and the majority of respondents (382 of 413 [92.1%]) noted satisfaction with their usual care physician. Of 435 participants, 287 (66.0%) reported requiring an ED visit for acute pain in the previous year. Respondents were less pleased with their ED care than their usual care clinician, with approximately half (146 of 287 [50.9%]) being satisfied with or perceiving having adequate quality care in the ED. Participants also noted that when they experienced severe pain or clinician lack of empathy, this was associated with a negative quality of care. Age group was associated with ED satisfaction, with younger patients (<19 vs 19-30 and 31-50 years) reporting better ED experiences. Conclusions and Relevance These results suggested that a negative perception of care may be a barrier for patients seeking care. These findings underscore the necessity of implementation studies to improve access to quality care for this population, especially in the acute care setting.
Collapse
Affiliation(s)
- Julie Kanter
- Department of Medicine, University of Alabama, Birmingham, Birmingham
| | - Robert Gibson
- Department of Hematology, Medical College of Georgia, Augusta University, Augusta
| | - Raymona H. Lawrence
- Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro
| | | | - Norma L. Pugh
- RTI International, Research Triangle Park, North Carolina
| | | | - Rita V. Masese
- Duke University School of Nursing, Durham, North Carolina
| | - Allison A. King
- Department of Pediatrics, Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
- Department of Medicine, Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
- Department of Surgery, Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
| | - Cecelia Calhoun
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jane S. Hankins
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Marsha Treadwell
- University of California, San Francisco, Benioff Children’s Hospital Oakland, Oakland
| |
Collapse
|
45
|
McKinney C, Caruso-Brown A, Montgomery K, Gillespie A, Coughlin R, Law D, Brouwer A, Tytler L, Hilden J, Nuss R. A Quality Initiative to Decrease Time to Antibiotics in Children with Sickle Cell Disease and Fever. Pediatr Qual Saf 2020; 5:e245. [PMID: 32190792 PMCID: PMC7056294 DOI: 10.1097/pq9.0000000000000245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/18/2019] [Indexed: 11/25/2022] Open
Abstract
Children with sickle cell disease (SCD) are at increased risk for sepsis secondary to functional asplenia. Timely administration of antibiotics, within 60 minutes of triage, is a national indicator of quality SCD care in the United States. However, there are no reports demonstrating the feasibility of doing so in the outpatient hematology-oncology clinic setting. Local Problem At baseline, in our pediatric hematology-oncology outpatient center, just 10% of children with SCD and fever received timely antibiotics. Methods We implemented a process improvement initiative for children with SCD and fever with the aim of ≥90% receiving timely antibiotics. We enacted interventions focused on general clinic processes from check-in to antibiotics and population-specific interventions, including an intravenous access protocol, notification/communication among staff members, and design of an electronic order set. Results The percentage of children receiving timely antibiotics improved from 10% to 77% with successful maintenance following the interventions. Residual delays are due to nonexpeditious order placement and difficult intravenous access. Conclusion Improving the timely administration of antibiotics in the outpatient hematology-oncology clinic setting for children with SCD and fever is possible. Achieving at least 90% timely antibiotics for children with SCD and fever in the outpatient clinic setting will require ongoing efforts at expeditious order placement and intravenous access.
Collapse
Affiliation(s)
- Christopher McKinney
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Amy Caruso-Brown
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Kathleen Montgomery
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Anne Gillespie
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Rebecca Coughlin
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Dawn Law
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Anna Brouwer
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Lauren Tytler
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo
| | - Joanne Hilden
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Rachelle Nuss
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colo.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.,Colorado Sickle Cell Treatment and Research Center, University of Colorado, Aurora, Colo
| |
Collapse
|
46
|
Understanding sickle cell disease: impact of surveillance and gaps in knowledge. Blood Adv 2020; 4:496-498. [PMID: 32027743 DOI: 10.1182/bloodadvances.2019001000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/20/2019] [Indexed: 01/19/2023] Open
|
47
|
Tavakoli S, Xiao L. Depletion of Intestinal Microbiome Partially Rescues Bone Loss in Sickle Cell Disease Male Mice. Sci Rep 2019; 9:8659. [PMID: 31209247 PMCID: PMC6572770 DOI: 10.1038/s41598-019-45270-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis or osteopenia are common clinical manifestations of sickle cell disease (SCD) with unclear mechanisms. Since senescence of circulating neutrophil can be modulated by signals derived from intestinal microbiome and neutrophils are abundant in bone marrow and can regulate osteoblasts and osteoclasts, we examined whether gut microbiome contributes to bone loss in SCD mice. SCD and their littermates control mice were treated with antibiotics to deplete gut microbiome. At the end of 7 weeks treatment, serum was collected for biochemistry marker measurements. Bone mass and remodeling were evaluated by dual beam X-ray absorptiometry, micro-computed tomography, and histomorphometry. Bone-related genes in tibia and barrier marker genes in the small intestine were analyzed by quantitative PCR. Antibiotic treatment rescued increased intestinal inflammatory cytokine marker genes (Tnfα, IL17, Ifnγ) expression, rescued decreased intestinal barrier marker genes (claudin 3 and claudin 15) expression, and rescued increased serum cytokines (IFNγ, IL27, IL10) in SCD mice. Antibiotic significantly improved decreased bone mass in SCD mice mainly through enhanced osteoblast function and increased osteoblast-related genes (Runx2 and Igf1) expression in SCD mice. Our findings support that increased bacteria load augments antigenic load traversing the impaired intestinal barrier through inflammation, leading to increased inflammatory cytokines, impaired osteoblast function, and bone loss in SCD mice.
Collapse
Affiliation(s)
- Sara Tavakoli
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA
| | - Liping Xiao
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA. .,Department of Psychiatry, UConn Health, Farmington, CT, 06030, USA.
| |
Collapse
|
48
|
El-Haj N, Hoppe CC. Newborn Screening for SCD in the USA and Canada. Int J Neonatal Screen 2018; 4:36. [PMID: 33072956 PMCID: PMC7548901 DOI: 10.3390/ijns4040036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/20/2018] [Indexed: 01/09/2023] Open
Abstract
Sickle cell disease (SCD) encompasses a group of inherited red cell disorders characterized by an abnormal hemoglobin, Hb S. The most common forms of SCD in the United States and Canada are identified through universal newborn screening (NBS) programs. Now carried out in all fifty U.S. states and 8 Canadian provinces, NBS for SCD represents one of the major public health advances in North America. The current status of NBS programs for hemoglobinopathies and the screening techniques employed in many regions worldwide reflect in large part the U.S. and Canadian experiences. Although the structure, screening algorithms and laboratory procedures, as well as reporting and follow up, vary between NBS programs, the overall workflow is similar. The current review summarized the historical background, current approaches, and methods used to screen newborns for SCD in the United States and Canada.
Collapse
Affiliation(s)
| | - Carolyn C. Hoppe
- Department of Hematology-Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA 94609, USA
| |
Collapse
|