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Croteau SE, Cutter S, Hernandez G, Wicklund B, Dreyer Gillette ML, Haugstad K, Cooper DL, Ostrow V, Nadglowski J. Awareness, Care and Treatment In Obesity maNagement to inform Haemophilia Obesity Patient Empowerment (ACTION-TO-HOPE): Results of a survey of US patients with haemophilia and obesity (PwHO) and their partners and caregivers. Haemophilia 2020; 26 Suppl 1:3-19. [PMID: 32017339 DOI: 10.1111/hae.13918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The ACTION study identified barriers to initiating and maintaining weight loss in patients with obesity; however, joint-related issues (pain, mobility and bleeding) may affect perceptions of patients with haemophilia and obesity (PwHO). AIM To identify patient and caregiver insights on the unique challenges of PwHO. METHODS Following IRB approval, adults who self-identified as PwHO, spouses/partners of adult PwHO, and caregivers of adolescent PwHO (aged 12-17 years) completed an online survey between December 2017 and April 2018. RESULTS Respondents included 124 adult PwHO, 45 spouses/partners and 42 caregivers. By calculated BMI, most adults were overweight (43%) or had obesity (51%); this differed from self-reported weight category. PwHO goals were improving health conditions (60%), having more energy (54%), reducing risks of weight (46%), and losing any weight (44%). Issues related to joint health were secondary for PwHO but frequently reported by spouses/parents. Most perceived weight loss to be a high priority (66%) and their responsibility (64%) but required a complete lifestyle change (63%). Most anticipated that weight loss would reduce joint pain (62%), bleeding (58%) and factor use (52%) and increase mobility (62%). Weight discussions with healthcare providers (HCPs) were commonly reported (51%). HCP discussions targeted improving health conditions (46%), achieving any weight loss (44%), being more active (73%) and improving eating habits (72%). Most PwHO (65%) perceived obesity as a disease and believe that 10% weight loss would be extremely beneficial (78%). In the past 5 years, 80% discussed being overweight and 68% losing weight; a minority reported being successful (9%) or somewhat successful (38%) with weight loss. More realistic or specific (51%/47%) goals, resources (46%), referrals to weight-loss programmes (41%) or dietitians (38%), meals or recipes (54%/50%), local or national (42%/41%) programmes for PwHO and success stories of PwHO (40%) are needed or would be helpful. CONCLUSIONS PwHO, spouse/partners and caregivers exhibited awareness of general and haemophilia-specific consequences of excess body weight. Most have tried general approaches to improve eating and increase activity with little success and desire more education on weight management and more details on specific actionable recommendations distributed through existing haemophilia channels. These insights will better inform the creation of weight-loss programmes for this community.
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Affiliation(s)
| | - Susan Cutter
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace Hernandez
- The Center for Inherited Blood Disorders, Orange, California
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Buckner TW, Sidonio R, Witkop M, Guelcher C, Cutter S, Iyer NN, Cooper DL. Correlations between patient-reported outcomes and self-reported characteristics in adults with hemophilia B and caregivers of children with hemophilia B: analysis of the B-HERO-S study. Patient Relat Outcome Meas 2019; 10:299-314. [PMID: 31572035 PMCID: PMC6755243 DOI: 10.2147/prom.s219166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023]
Abstract
Purpose Pain, anxiety, depression, and other aspects of health-related quality of life (HRQoL) are important issues for people with hemophilia and caregivers of children with hemophilia. Patient-reported outcome (PRO) instruments may be used to assess aspects of HRQoL; however, the use of PROs in clinical management of patients with hemophilia is limited and inconsistent. The Bridging Hemophilia B Experiences, Results and Opportunities Into Solutions (B-HERO-S) study evaluated the impact of hemophilia B on HRQoL and other psychosocial aspects in affected adults and caregivers of children with hemophilia B. This post hoc analysis assessed correlations between PRO scores and psychosocial questions commonly asked in comprehensive care settings among B-HERO-S respondents. Patients and methods B-HERO-S consisted of two online surveys, one administered to adults with hemophilia B (n=299) and one administered to caregivers of children with hemophilia B (n=150). The adult survey included EQ-5D-5L with visual analog scale, BPI, HAL, and PHQ-9. The caregiver survey included PHQ-9 and GAD-7. Questions related to demographics, hemophilia treatment, and psychosocial questions asked in comprehensive care visits were also included in the surveys. A post hoc analysis was performed to assess correlations between responses to selected psychosocial questions with PRO scores. Results For adults with hemophilia B, greater pain severity and pain interference scores were associated with work-related problems, functional limitations, and relationship, psychological, and treatment issues. Significant correlations were also noted between some of these psychosocial outcomes and depressive symptoms. For caregivers, greater depression and anxiety were associated with employment issues, their child’s functional, relationship, and psychological issues, having had difficulty or concerns with treatment/factor availability or affordability, and having less frequent HTC visits. Conclusion High correlations were observed between PRO scores measuring pain, depression, and anxiety and questions commonly used in the comprehensive care setting to assess the psychosocial impact of hemophilia.
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Affiliation(s)
- Tyler W Buckner
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert Sidonio
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Christine Guelcher
- Hemostasis and Thrombosis Program, Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC, USA
| | - Susan Cutter
- Penn Comprehensive Hemophilia and Thrombosis Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Cutter S, Guelcher C, Hunter S, Rotellini D, Dunn S, Cooper DL. Mild-severe hemophilia B impacts relationships of US adults and children with hemophilia B and their families: results from the B-HERO-S study. Patient Relat Outcome Meas 2019; 10:257-266. [PMID: 31496854 PMCID: PMC6701620 DOI: 10.2147/prom.s214188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/29/2019] [Indexed: 01/19/2023]
Abstract
Background The B-HERO-S study evaluated the impact of mild to severe hemophilia B on the lives of affected adults and children. Here, we assessed the impact of hemophilia B on relationships. Methods US adults with hemophilia B and caregivers of affected children completed separate online surveys that included questions regarding impact of the disease on interpersonal relationships. Results Most (88%) of the 299 adults completing the survey had mild to moderate hemophilia B. Of those, 54% were married or in a long-term relationship, and 44% were single. Most adults (87%) reported that hemophilia affected their ability to form close relationships with partners or prospective partners; 35% were very/quite dissatisfied with the support received from a previous partner. Nearly all participants (98%) were very/quite satisfied with the support received from their current partner. Most were very/quite satisfied with the support from family (87%) and friends (96%). Most participants reported a negative reaction or experience as a result of disclosing their hemophilia (friend/colleague/employer, 76%/80%/82%, respectively). Of 150 caregivers of children with mostly mild to moderate hemophilia (74%), 89% were married or in a long-term relationship, and most felt very well/quite supported by their partner (98%) and family (92%). Most felt very/quite satisfied with the support of teachers (94%), children at school (80%), and other adults in regular contact (72%). Most caregivers reported negative experiences telling a friend (76%) or having their child tell a friend (69%) about the child’s hemophilia; 43% reported that their child was bullied because of his/her hemophilia. Conclusion Although the impact of severe hemophilia on relationships has been reported in HERO and other studies, B-HERO-S suggested that mild to moderate hemophilia B also significantly influences relationships of affected men/women and boys/girls, especially in disclosing their diagnosis, selecting a partner, and feeling bullied by peers/colleagues.
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Affiliation(s)
- Susan Cutter
- Penn Comprehensive Hemophilia and Thrombosis Program, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Christine Guelcher
- Comprehensive Hemostasis and Thrombosis Program, Children's National Health System, Washington, DC, USA
| | - Susan Hunter
- Hemostasis and Thrombosis Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Spencer Dunn
- Center for Comprehensive Care and Diagnosis of Inherited Bleeding Disorders, Orange, CA, USA
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Blamey G, Buranahirun C, Buzzi A, Cooper DL, Cutter S, Geraghty S, Saad H, Yang R. Hemophilia and sexual health: results from the HERO and B-HERO-S studies. Patient Relat Outcome Meas 2019; 10:243-255. [PMID: 31616195 PMCID: PMC6698588 DOI: 10.2147/prom.s211339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/09/2019] [Indexed: 12/01/2022]
Abstract
Background Sexual health plays a primary role in quality of life (QoL) for many people, including those with hemophilia; however, there is little information available about sexual relationships and satisfaction in patients with hemophilia. Methods To address this issue, the Hemophilia Experiences, Results and Opportunities (HERO) and the Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) studies included questions from the Male Sexual Health Questionnaire (MSHQ). Results Although these data were not statistically analyzed for comparisons between the 3 populations (HERO, HERO US only, and B-HERO-S), in general, participants in the HERO survey appeared to be more satisfied with their sexual relationship than participants in the B-HERO-S survey. In addition, many patients, especially those outside the United States, reported that they had not discussed sexual health with their doctor or other members of the hemophilia treatment center team. While the topic of sexual health has been infrequently explored in men with hemophilia, this is the first time it has been investigated in women with hemophilia. Conclusion The results of these studies demonstrate that the impact of hemophilia extends to intimacy and suggest the need for large-scale studies in additional countries to explore further the factors associated with sexual health issues in people with hemophilia.
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Affiliation(s)
- Greig Blamey
- Physiotherapy Department, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Cathy Buranahirun
- Children's Center for Cancer and Blood Diseases, Keck School of Medicine, University of Southern California/Children's Hospital Los Angeles , Los Angeles, CA, USA
| | | | | | - Susan Cutter
- Penn Comprehensive Hemophilia and Thrombosis Program, Hospital of the University of Pennsylvania , Philadelphia, PA, USA
| | - Sue Geraghty
- University of Colorado Hemophilia and Thrombosis Center-Retired , Denver, CO, USA
| | | | - Renchi Yang
- Tianjin Hemophilia Center , Tianjin, People's Republic of China
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Cutter S, Molter D, Dunn S, Hunter S, Peltier S, Haugstad K, Frick N, Holot N, Cooper DL. Impact of mild to severe hemophilia on education and work by US men, women, and caregivers of children with hemophilia B: The Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) study. Eur J Haematol 2017; 98 Suppl 86:18-24. [PMID: 28319337 DOI: 10.1111/ejh.12851] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 12/01/2022]
Abstract
The psychosocial impact of hemophilia on work was recently investigated in the Hemophilia Experiences, Results and Opportunities (HERO) study. The findings revealed that hemophilia had an impact for adults with moderate/severe hemophilia and caregivers of children with hemophilia. HERO did not specifically evaluate impact on education in adults/children with mild/moderate hemophilia or the impact on employment of spouses/partners of caregivers of affected children. The Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) study evaluated the impact of hemophilia on the lives of adult men/women with mild-severe hemophilia B and caregivers of boys/girls with hemophilia B and their spouses/partners. Many adults with hemophilia B (94%) reported that hemophilia had a negative effect on their ability to complete a formal education, often attributed to the inability to attend or concentrate in school as a result of hemophilia-related bleeding or pain. Most adults with hemophilia B (95%) and caregivers/partners (89%/84%) indicated that hemophilia had a negative impact on employment. Most adults with hemophilia were employed (81%), with construction/manufacturing (35%) as the most frequently reported industry; many worked in jobs requiring manual labor (39%). Of those unemployed, 62% never worked, and those who stopped working reported that they left the workforce due to financial issues (59%), including insurance coverage/co-pays, or hemophilia-related issues (55%). Nearly one-third of caregivers voluntarily left the workforce to care for children with hemophilia. These results suggest a need to focus more effort on career counseling for adults with hemophilia B and caregivers of affected children, especially around mild/moderate hemophilia, as this population may not be as well informed regarding potential impact in school and the workplace.
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Affiliation(s)
- Susan Cutter
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Don Molter
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA
| | - Spencer Dunn
- Center for Comprehensive Care and Diagnosis of Inherited Bleeding Disorders, Orange, CA, USA
| | - Susan Hunter
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Skye Peltier
- Center for Bleeding and Clotting Disorders, University of Minnesota Health, Minneapolis, MN, USA
| | | | - Neil Frick
- National Hemophilia Foundation, New York, NY, USA
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Baumann K, Hernandez G, Witkop M, Peltier S, Dunn S, Cutter S, Frick N, Haugstad K, Guelcher C, Frey MJ, Rotellini D, Clark DB, Iyer NN, Cooper DL. Impact of mild to severe hemophilia on engagement in recreational activities by US men, women, and children with hemophilia B: The Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) study. Eur J Haematol 2017; 98 Suppl 86:25-34. [PMID: 28319336 DOI: 10.1111/ejh.12852] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 11/30/2022]
Abstract
The psychosocial impact of hemophilia on activities was recently investigated in the Hemophilia Experiences, Results and Opportunities (HERO) study (675 people with hemophilia and 561 caregivers of children with hemophilia in 10 countries). The impact of hemophilia B may not be accurately reflected in the HERO results, as ~75% of respondents described issues affecting males with hemophilia A. To address the needs of this population, the Bridging Hemophilia B Experiences, Results and Opportunities Into Solutions (B-HERO-S) was developed as a pilot study in the United States in collaboration with the hemophilia community. The analysis reported here assessed engagement in recreational activities and changes to treatment regimens around activities as reported by 299 adults with hemophilia B and 150 caregivers of children with hemophilia B. Nearly all adults with hemophilia B (98%) experienced a negative impact on their participation in recreational activities due to hemophilia-related issues, and most caregivers (90%) reported that hemophilia B had a negative impact on their child's engagement in recreational activities. One of the main reasons identified for discontinuing past activities was the risk of bruising or bleeding (adults/children with hemophilia B, 49%/41%). In particular, adults with hemophilia B reported a history of activity-related bleeding, and most adults decreased their participation in high-risk activities as they aged. Substantial percentages of adults and children with hemophilia B (including mild/moderate severity) altered their treatment regimens to accommodate planned activities. These findings may help inform guidelines for individualizing treatment regimens around participation in recreational activities based on hemophilia severity, baseline factor level, and activity risk and intensity.
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Affiliation(s)
- Kimberly Baumann
- Center for Bleeding and Clotting Disorders, University of Minnesota Health, Minneapolis, MN, USA
| | - Grace Hernandez
- Center for Comprehensive Care and Diagnosis of Inherited Bleeding Disorders, Orange, CA, USA
| | | | - Skye Peltier
- Center for Bleeding and Clotting Disorders, University of Minnesota Health, Minneapolis, MN, USA
| | - Spencer Dunn
- Center for Comprehensive Care and Diagnosis of Inherited Bleeding Disorders, Orange, CA, USA
| | - Susan Cutter
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Neil Frick
- National Hemophilia Foundation, New York, NY, USA
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Witkop M, Guelcher C, Forsyth A, Quon D, Hawk S, Curtis R, Cutter S, Molter D, Cooper DL. Challenges in transition to adulthood for young adult patients with hemophilia: Quantifying the psychosocial issues and developing solutions. Am J Hematol 2015; 90 Suppl 2:S1-2. [PMID: 26619191 DOI: 10.1002/ajh.24217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/13/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Doris Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children; Los Angeles California
| | - Sarah Hawk
- Oklahoma Center for Bleeding Disorders; Oklahoma City Oklahoma
| | | | - Susan Cutter
- Penn Comprehensive Hemophilia and Thrombosis Center, University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Don Molter
- Indiana Hemophilia and Thrombosis Center; Indianapolis Indiana
| | - David L. Cooper
- Clinical Development, Medical and Regulatory Affairs, Novo Nordisk Inc; Plainsboro, New Jersey
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Quon D, Reding M, Guelcher C, Peltier S, Witkop M, Cutter S, Buranahirun C, Molter D, Jane Frey M, Forsyth A, Tran DB, Curtis R, Hiura G, Levesque J, de la Riva D, Compton M, Iyer NN, Holot N, Cooper DL. Unmet needs in the transition to adulthood: 18- to 30-year-old people with hemophilia. Am J Hematol 2015; 90 Suppl 2:S17-22. [PMID: 26619193 DOI: 10.1002/ajh.24219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/13/2015] [Indexed: 11/05/2022]
Abstract
Young adults with hemophilia face unique challenges during the transition to adulthood, including issues associated with switching from pediatric to adult hematology care, building mature interpersonal relationships, and establishing an independent career with an assurance of medical insurance coverage. A greater understanding of these challenges is essential for developing effective strategies to address the specific needs of this population. These challenges may be differentiated from those of older adults with hemophilia in large part because of more extensive childhood prophylaxis and safer factor products, resulting in fewer joint problems and lower rates of HIV and HCV infections. This analysis of the changing nature and unmet needs of today's young adults entering into adult hemophilia treatment centers, as well as potential strategies for optimally addressing these needs, was developed following roundtable discussions between patients, caregivers, hematologists, and other health care professionals participating in comprehensive care. Challenges identified among young adults with hemophilia include psychosocial issues related to maturity, personal responsibility, and increased independence, as well as concerns regarding when and with whom to share information about one's hemophilia, limited awareness of educational and financial resources, and a low perceived value of regular hematology care. The initiatives proposed herein highlight important opportunities for health care professionals at pediatric and adult hemophilia treatment centers, as well as national organizations, community groups, and career counselors, to address key unmet needs of this patient population.
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Affiliation(s)
- Doris Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children; Los Angeles California
| | - Mark Reding
- University of Minnesota Medical Center; Minneapolis Minnesota
| | | | - Skye Peltier
- Oregon Health & Science University; Portland Oregon
| | | | - Susan Cutter
- Penn Comprehensive Hemophilia and Thrombosis Center, University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Cathy Buranahirun
- Children's Hospital Los Angeles, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Don Molter
- Indiana Hemophilia and Thrombosis Center; Indianapolis Indiana
| | | | | | | | | | - Grant Hiura
- National Hemophilia Foundation; New York New York
| | | | - Debbie de la Riva
- Lone Star Chapter of the National Hemophilia Foundation; Houston Texas
| | - Matthew Compton
- Adult Patient, Compton Consulting LLC; Simi Valley California
| | - Neeraj N. Iyer
- Clinical Development; Medical and Regulatory Affairs, Novo Nordisk Inc; Plainsboro New Jersey
| | - Natalia Holot
- Clinical Development; Medical and Regulatory Affairs, Novo Nordisk Inc; Plainsboro New Jersey
| | - David L. Cooper
- Clinical Development; Medical and Regulatory Affairs, Novo Nordisk Inc; Plainsboro New Jersey
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Cutter S, Deutsche J, Santaella M, Chapman R, Lafranco J, Lambing A, Witkop M. Emerging Therapies for Hemophilia: A New Era of Care and the Role of the Interdisciplinary Team. Semin Thromb Hemost 2014; 40:790-802. [DOI: 10.1055/s-0034-1384636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Susan Cutter
- Penn Comprehensive Hemophilia and Thrombosis Program, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joann Deutsche
- Oregon Hemophilia Center, Oregon Health and Science Center, Portland, Oregon
| | - Maria Santaella
- Miami Hemophilia Treatment Center, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Jennifer Lafranco
- Clinical Programs, Mary M. Gooley Hemophilia Center, Rochester General, Rochester, New York
| | - Angela Lambing
- Henry Ford Hospital, Hemophilia Treatment Center, Detroit, Michigan
| | - Michelle Witkop
- Northern Regional Bleeding Disorders Center, Traverse City, Michigan
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Baker JR, Riske B, Voutsis M, Cutter S, Presley R. Insurance, home therapy, and prophylaxis in U.S. youth with severe hemophilia. Am J Prev Med 2011; 41:S338-45. [PMID: 22099356 DOI: 10.1016/j.amepre.2011.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 08/19/2011] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Home infusion therapy, particularly on a prophylactic regimen, is linked with reduced morbidity among youth with severe hemophilia. However, the association of insurance coverage with these home therapies is unknown. PURPOSE This study explores the connections among insurance, home infusion therapy, and prophylaxis treatment in a nationwide cohort of 3380 boys and young men (aged 2 to 20 years) with severe hemophilia. These youth obtained care at one of 129 federally supported hemophilia treatment centers (HTCs), and enrolled in the CDC's bleeding disorder surveillance project. METHODS Multiple regression was used to analyze the independent association among risk factors, including insurance, and both home infusion and prophylaxis. Data were obtained between January 1, 2008, and December 31, 2010, and analyzed in 2011. RESULTS Ninety percent used home therapy and 78% a prophylaxis regimen. Only 2% were uninsured. Health insurance was significantly associated with prophylaxis, but not with home therapy. Lower prophylaxis utilization rates were independently associated with having Medicaid, "other," and no insurance as compared to having private insurance. Race, age, inhibitor status, and HTC utilization were also independently associated with both home therapy and prophylaxis. CONCLUSIONS Youth with severe hemophilia who annually obtain care within the U.S. HTC network had a high level of health insurance, home therapy, and prophylaxis. Exploration of factors associated with insurance coverage and yearly HTC utilization, and interventions to optimize home infusion and prophylaxis among youth of African-American and "other" race/ethnic backgrounds are warranted.
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Affiliation(s)
- Judith R Baker
- Department of Pediatric Hematology/Oncology, University of California Los Angeles, Los Angeles, California 90095, USA.
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Cutter S. Lessening the Impact of Disasters. Amer Scientist 2008. [DOI: 10.1511/2008.70.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Eyster ME, Schaefer JH, Ragni MV, Gorenc TJ, Shapiro S, Cutter S, Kajani MK, Abrams J, Barron LE, Odenwelder A. Changing causes of death in Pennsylvania's hemophiliacs 1976 to 1991: impact of liver disease and acquired immunodeficiency syndrome. Blood 1992; 79:2494-5. [PMID: 1571565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Abstract
The responses of the residents to the nuclear power plant arcident at Three Mile Island, Pennsylvania illustrate the factors influencing pre-impact coping responses of populations exposed to technological hazards. Confusion itnd ambiguous information influenced both the decision to evaluate and to remain in place. Proximity to the facility, stage in life cycle and the actions of friends and neighbors influenced the decision to evacuate.
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Affiliation(s)
- S Cutter
- Department of Geography Rutgers State University New Brunswick NJ 08903, U.S.A
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