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

Lydia H Pecker1, Sarah Kappa2, Adam Greenfest3

  • 1Division of Hematology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD.

The Journal of Pediatrics
|September 26, 2018
PubMed

Insights

An initiative to increase hydroxyurea use in children with sickle cell anemia (SCA) significantly boosted treatment initiation and adherence. This approach improved hydroxyurea uptake in eligible patients presenting to the emergency department (ED).

Area of Science:

  • Hematology
  • Pediatric Medicine
  • Public Health Initiatives

Background:

  • Sickle cell anemia (SCA) is a serious condition requiring effective management.
  • Hydroxyurea is a crucial treatment for SCA, but its uptake can be challenging.
  • Emergency department (ED) visits present opportunities to initiate or optimize SCA treatment.

Purpose of the Study:

  • To assess the effectiveness of a targeted initiative in increasing hydroxyurea use among pediatric SCA patients.
  • To evaluate the impact of the Quick-Start Hydroxyurea Initiation Project (Q-SHIP) on hydroxyurea initiation and adherence.
  • To determine if Q-SHIP participation influences hydroxyurea use compared to non-participants.

Main Methods:

  • An observational cohort study was conducted involving children with SCA presenting to the ED without hydroxyurea.
  • Eligible patients attended a Q-SHIP session, featuring expert discussion, patient testimonials, and an immediate offer to start hydroxyurea.
  • Hydroxyurea initiation, adherence, and relevant laboratory markers (mean corpuscular volume, hemoglobin F) were tracked.

Main Results:

  • 59% of eligible ED patients participated in Q-SHIP, with 55% starting hydroxyurea.
  • Hydroxyurea adherence was high (83%) among those who started the medication, supported by increased mean corpuscular volume and hemoglobin F levels.
  • Q-SHIP participants were significantly more likely to start and continue hydroxyurea compared to non-participants, leading to an overall increase in hydroxyurea use from 56% to 80% in eligible ED patients.

Conclusions:

  • A dedicated clinic session focused on initiating hydroxyurea after an SCA complication effectively increases its use.
  • The Q-SHIP model demonstrates success in improving hydroxyurea initiation and sustained use in pediatric SCA patients.
  • Targeted interventions in the ED setting can significantly enhance adherence to essential SCA therapies.
Abstract

Keywords:
hydroxyureapatient educationpediatricssickle cell disease

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