Ambulatory quality indicators to prevent infection in sickle cell disease

Area of Science:

• Pediatric Hematology
• Public Health
• Quality of Care Research

Background:

• Sickle cell disease (SCD) management requires adherence to preventative care guidelines.
• Previous research suggests specific quality indicators are vital for assessing SCD care.
• Adherence to vaccinations and prophylactic medications is critical for reducing complications in SCD patients.

Purpose of the Study:

• To determine adherence rates for influenza vaccination, pneumococcal immunizations, and penicillin prophylaxis in Medicaid patients with SCD.
• To evaluate adherence differences between pediatric and adult populations with SCD.
• To identify potential areas for improving the quality of outpatient care for individuals with SCD.

Main Methods:

• Retrospective cohort study utilizing the Wisconsin State Medicaid database (2003-2007).
• Analysis of preventative medication adherence for influenza vaccine, pneumococcal vaccines (PCV7, PPV23), and penicillin prophylaxis.
• Comparison of adherence rates between children and adults with SCD.

Main Results:

• Low adherence observed for influenza vaccinations (21.58%) and penicillin prophylaxis (18.18%).
• Moderate adherence for PPV23 pneumococcal immunizations (43.47%), but high adherence for PCV7 (77.27%).
• Children generally demonstrated higher adherence rates than adults, though overall adherence remained suboptimal.

Conclusions:

• Significant gaps exist in the adherence to recommended preventative care for patients with SCD in a Medicaid population.
• Low adherence is likely multifactorial, involving both patient- and provider-level issues.
• Collaborative partnerships between patients and providers are essential for improving adherence to preventative care recommendations.