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Lamont AE, Hsu LL, Jacobs S, Gibson R, Treadwell M, Chen Y, Lottenberg R, Axelrod K, Varughese T, Melvin C, Smith S, Chukwudozie IB, Kanter J. What does it mean to be affiliated with care?: Delphi consensus on the definition of "unaffiliation" and "specialist" in sickle cell disease. PLoS One 2022; 17:e0272204. [PMID: 36367870 PMCID: PMC9651581 DOI: 10.1371/journal.pone.0272204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Accruing evidence reveals best practices for how to help individuals living with Sickle Cell Disease (SCD); yet, the implementation of these evidence-based practices in healthcare settings is lacking. The Sickle Cell Disease Implementation Consortium (SCDIC) is a national consortium that uses implementation science to identify and address barriers to care in SCD. The SCDIC seeks to understand how and why patients become unaffiliated from care and determine strategies to identify and connect patients to care. A challenge, however, is the lack of agreed-upon definition for what it means to be unaffiliated and what it means to be a "SCD expert provider". In this study, we conducted a Delphi process to obtain expert consensus on what it means to be an "unaffiliated patient" with SCD and to define an "SCD specialist," as no standard definition is available. Twenty-eight SCD experts participated in three rounds of questions. Consensus was defined as 80% or more of respondents agreeing. Experts reached consensus that an individual with SCD who is unaffiliated from care is "someone who has not been seen by a sickle cell specialist in at least a year." A sickle cell specialist was defined as someone with knowledge and experience in SCD. Having "knowledge" means: being knowledgeable of the 2014 NIH Guidelines, "Evidence-Based Management of SCD", trained in hydroxyurea management and transfusions, trained on screening for organ damage in SCD, trained in pain management and on SCD emergencies, and is aware of psychosocial and cognitive issues in SCD. Experiences that are expected of a SCD specialist include experience working with SCD patients, mentored by a SCD specialist, regular attendance at SCD conferences, and obtains continuing medical education on SCD every 2 years." The results have strong implications for future research, practice, and policy related to SCD by helping to lay a foundation for an new area of research (e.g., to identify subpopulations of unaffiliation and targeted interventions) and policies that support reaffiliation and increase accessibility to quality care.
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Affiliation(s)
| | - Lewis L. Hsu
- University of Illinois, Chicago, Illinois, United States of America
| | - Sara Jacobs
- RTI International, Research Triangle Park, NC, United States of America
| | - Robert Gibson
- Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Marsha Treadwell
- UCSF School of Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Yumei Chen
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | | | - Kathleen Axelrod
- RTI International, Research Triangle Park, NC, United States of America
| | - Taniya Varughese
- Washington University St Louis, St. Louis MO, United States of America
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Sharon Smith
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, United States of America
| | | | - Julie Kanter
- University of Alabama, Birmingham, Birmingham, AL, United States of America
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Ribeiro AJT, Amorim FF, Soares BMD, Santana LA, Imoto AM. Functional and joint evaluation in a prospective cohort of patients with severe haemophilia. Haemophilia 2021; 27:314-320. [PMID: 33550664 DOI: 10.1111/hae.14243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Arthropathy is the main morbidity of haemophilia. Periodic joint health assessment enables a better understanding of the limitations of these patients. OBJECTIVE To evaluate the functional and joint performance in patients with haemophilia at one-year follow-up, as well as its association with prophylactic treatment and attendance at scheduled consultations at a haemophilia treatment centre. METHODS This prospective cohort study included patients with severe haemophilia aged 7 years or more and treated at Fundação Hemocentro de Brasília, Brazil, from January 2014 to December 2018. The Hemophilia Joint Health Score and Functional Independence Score in Hemophilia were assessed at the first consultation and after a one-year follow-up. RESULTS The study included 69 patients. The mean age at study recruitment was 22.5 ± 4.5 years, 62.3% of patients aged 18 years or older, and 29 patients were receiving primary prophylaxis (38.0%). There was a positive correlation between HJHS and age and a negative correlation between FISH and age. The worsening HJHS was associated with non-primary prophylaxis and non-attendance at scheduled multidisciplinary consultations. The worsening FISH was associated with non-primary prophylaxis. The correlation between FISH and treatment adherence was significant for the delta. CONCLUSION The older the patient with haemophilia, the higher the probability of a worsening of the HJHS. In the presence of more arthropathies, the older the patient, the worse the FISH. Patients receiving primary prophylaxis show better results in the HJHS and FISH when compared to patients receiving secondary prophylaxis and/or on-demand treatment.
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Affiliation(s)
- Alexandre Jorge Teixeira Ribeiro
- Mestrado Acadêmico da, Escola Superior em Ciências da Saúde, Brasília, DF, Brazil.,Fundação Hemocentro de Brasília, Brasília, DF, Brazil
| | - Fábio Ferreira Amorim
- Programa de Mestrado Acadêmico and Laboratório de Saúde Baseada em Evidências, Escola Superior em Ciências da Saúde, Brasília, DF, Brazil
| | - Beatriz Mac Dowell Soares
- Curso de Medicina da, Escola Superior em Ciências da Saúde, Brasília, DF, Brazil.,Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil
| | - Levy Aniceto Santana
- Laboratório de Saúde Baseada em Evidências and Mestrado Profissional em Ciências para a Saúde, Escola Superior em Ciências da Saúde, Brasília, DF, Brazil
| | - Aline Mizusaki Imoto
- Mestrado Acadêmico da, Escola Superior em Ciências da Saúde, Brasília, DF, Brazil.,Laboratório de Saúde Baseada em Evidências and Mestrado Profissional em Ciências para a Saúde, Escola Superior em Ciências da Saúde, Brasília, DF, Brazil
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Bjork JM, Reisweber J, Burchett JR, Plonski PE, Konova AB, Lopez-Guzman S, Dismuke-Greer CE. Impulsivity and Medical Care Utilization in Veterans Treated for Substance Use Disorder. Subst Use Misuse 2021; 56:1741-1751. [PMID: 34328052 DOI: 10.1080/10826084.2021.1949603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Impulsivity has been defined by acting rashly during positive mood states (positive urgency; PU) or negative mood states (negative urgency; NU) and by excessive de-valuation of deferred rewards. These behaviors reflect a "live in the now" mentality that is not only characteristic of many individuals with severe substance use disorder (SUD) but also impedes medical treatment compliance and could result in repeated hospitalizations or other poor health outcomes. Purpose/objectives: We sought preliminary evidence that impulsivity may relate to adverse health outcomes in the veteran population. Impulsivity measured in 90 veterans receiving inpatient or outpatient SUD care at a Veterans Affairs Medical Center was related to histories of inpatient/residential care costs, based on VA Health Economics Resource Center data. Results: We found that positive urgency, lack of persistence and lack of premeditation, but not sensation-seeking or preference for immediate or risky rewards, were significantly higher in veterans with a history of one or more admissions for VA-based inpatient or residential health care that either included (n = 30) or did not include (n = 29) an admission for SUD care. Among veterans with a history of inpatient/residential care for SUD, NU and PU, but not decision-making behavior, correlated with SUD care-related costs. Conclusions/Importance: In veterans receiving SUD care, questionnaire-assessed trait impulsivity (but not decision-making) related to greater care utilization within the VA system. This suggests that veterans with high impulsivity are at greater risk for adverse health outcomes, such that expansion of cognitive interventions to reduce impulsivity may improve their health.
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Affiliation(s)
- James M Bjork
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Jarrod Reisweber
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Jason R Burchett
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Paul E Plonski
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Anna B Konova
- Department of Psychiatry, University Behavioral Health Care, and the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, NJ, USA
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Soares BMD, Simeoni LA, de Almeida KJQ, de Souza JL, Mizusaki Imoto A, Swain Braverman M, Bezerra LB, Ribeiro AJT, Costa AM, Amorim FF. Factors Associated with Compliance with the Treatment Protocol and Mortality in Adults with Hemophilia. Patient Prefer Adherence 2020; 14:2279-2285. [PMID: 33262579 PMCID: PMC7691649 DOI: 10.2147/ppa.s279401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Hemophilia is associated with a high prevalence of disabilities and mortality. This finding can be influenced by patient compliance with the treatment protocol. This study aims to identify compliance with a treatment protocol in adult patients with hemophilia and to evaluate the factors associated with and the impact on mortality of noncompliance with a hemophilia treatment protocol. METHODS This was a cross-sectional study that was performed between June 2015 and May 2016, followed by a cohort to evaluate mortality until July 2019 that included all adult patients with hemophilia registered in the Federal District, Brazil. RESULTS Among 138 patients enrolled in the study, 35 patients were compliant with all items of the treatment protocol (25.4%). Regarding each item, compliance with the medical consultations was 71.0% (98/138); the clotting factor regimen was 65.9% (91/138); and the serological tests were 51.4% (71/138). The mortality was 7.2% (10/138). Noncompliance with any aspect of the protocol was associated with mortality: medical consultations (p<0.001), clotting factor regimen (p=0.013), and serological tests (p=0.006). All deaths occurred in those who did not comply with the protocol, and the majority were due to bleeding. Patients who were noncompliant with all protocol items showed the highest mortality (50.0%, 5/10). Treatment at the hemophilia treatment center (OR: 2.388; 95% CI: 1.052-5.418, p=0.037) was positively and independently associated with compliance with the protocol in multivariate analysis. CONCLUSION Noncompliance with the treatment protocol was high. Treatment at a hemophilia treatment center was positively and independently associated with compliance with the protocol, which reinforces the importance of comprehensive care by a multidisciplinary team.
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Affiliation(s)
- Beatriz Mac Dowell Soares
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Faculty of Health Sciences, University of Brasilia (UnB) – Brasília, Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Correspondence: Beatriz Mac Dowell Soares School of Medicine, Escola Superior de Ciências da Saúde (ESCS), SMHN Conjunto A Bloco 01 Edifício Fepecs – Asa Norte, Brasília – DF, BrasíliaCEP: 70710-907, Federal District, Brazil, Tel +55 61999836446 Email
| | - Luiz Alberto Simeoni
- Faculty of Health Sciences, University of Brasilia (UnB) – Brasília, Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Karlo Jozefo Quadros de Almeida
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Jaqueline Lima de Souza
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Aline Mizusaki Imoto
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Brasília Hemocentro Foundation (FHB), SMHN Conjunto A Bloco 3, Brasília, Federal District, Brazil
| | - Melina Swain Braverman
- Brasília Hemocentro Foundation (FHB), SMHN Conjunto A Bloco 3, Brasília, Federal District, Brazil
| | - Lucas Barbosa Bezerra
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Alexandre Jorge Teixeira Ribeiro
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Brasília Hemocentro Foundation (FHB), SMHN Conjunto A Bloco 3, Brasília, Federal District, Brazil
| | - Ana Maria Costa
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Fábio Ferreira Amorim
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Faculty of Health Sciences, University of Brasilia (UnB) – Brasília, Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
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