Targeted Hydroxyurea Education after an Emergency Department Visit Increases Hydroxyurea Use in Children with Sickle Cell Anemia

Lydia Pecker, Sarah Kappa, Adam Greenfest, Deepika S. Darbari, Robert Sheppard Nickel

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the impact of an initiative to increase hydroxyurea use among children with sickle cell anemia (SCA) who presented to the emergency department (ED). Study design: This observational cohort study included children with SCA not taking hydroxyurea who presented to the ED with pain or acute chest syndrome and then attended a Quick-Start Hydroxyurea Initiation Project (Q-SHIP) session. A Q-SHIP session includes a hematologist-led discussion on hydroxyurea, a video of patients talking about hydroxyurea, and a direct offer to start hydroxyurea. Results: Over 64 weeks, 112 eligible patients presented to the ED and 59% (n = 66) participated in a Q-SHIP session a median of 6 days (IQR 2, 20 days) after ED or hospital discharge; 55% of participants (n = 36) started hydroxyurea. After a median follow-up of 49 weeks, 83% (n = 30) of these participants continued hydroxyurea. Laboratory markers of hydroxyurea adherence were significantly increased from baseline: median mean corpuscular volume +8.6 fL (IQR 5.0, 17.7, P <.0001) and median hemoglobin F +5.7% (IQR 2.5, 9.8, P =.0001). Comparing Q-SHIP participants to nonparticipants, 12 weeks after ED visit, participants were more likely to have started hydroxyurea than nonparticipants (53% vs 20%, P =.0004) and to be taking hydroxyurea at last follow-up (50% vs 20%, P =.001). Two years after the implementation of Q-SHIP the overall proportion of eligible patients on hydroxyurea presenting to our ED increased from 56% to 80%, P =.0069. Conclusions: Participation in a clinic to specifically address starting hydroxyurea after a SCA complication increases hydroxyurea use.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Keywords

  • hydroxyurea
  • patient education
  • pediatrics
  • sickle cell disease

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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