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BACKGROUND Hydroxyurea therapy prevents disease complications among patients with sickle cell disease (SCD). Despite the evidence for its efficacy and endorsement by the National Health Lung and Blood Institute (NHLBI) evidence-based guidelines, adoption of this therapy is low, both by patients with SCD and their providers. Mobile health (mHealth) applications provide benefit in improving medication adherence and self-efficacy among patients with chronic diseases and have facilitated prescribing among medical providers. However, mHealth has not been systematically tested as a tool to increase hydroxyurea adherence, nor has the combination of mHealth been assessed at both patient and provider levels to increase hydroxyurea utilization. OBJECTIVE To increase hydroxyurea utilization through a combined two-level mHealth intervention approach for both patients with SCD and their providers. The goals are to increase adherence to hydroxyurea therapy among patients with SCD and improve hydroxyurea prescribing behavior among providers of patients with SCD. METHODS We will test the efficacy of two mHealth interventions to increase both patients’ and providers’ utilization and knowledge of hydroxyurea within eight clinical sites of the NHLBI-funded Sickle Cell Disease Implementation Consortium (SCDIC). The patient mHealth intervention, InCharge Health, includes multiple components that addresses memory, motivation, and knowledge barriers to hydroxyurea use. The provider mHealth intervention, Hydroxyurea Toolbox (HU Toolbox) addresses the clinical knowledge barriers in prescribing and monitoring hydroxyurea. The primary hypothesis is that among adolescents and adults with SCD, adherence to hydroxyurea, as measured by the proportion of days covered (the ratio of the number of days the patient is covered by the medication to the number of days in the treatment period), will increase by at least 20% after 24 weeks of receiving the InCharge Health app, compared to their adherence at baseline. As secondary objectives, we will 1) examine the change in health-related quality of life, acute disease complications, perceived health literacy and perceived self-efficacy in taking hydroxyurea among patients who use InCharge Health, and 2) examine potential increases in the awareness of hydroxyurea benefits and risks, appropriate prescribing, and perceived self-efficacy to correctly administer hydroxyurea therapy among SCD providers between baseline and 9 months of using the HU Toolbox app. We will measure the reach, adoption, implementation, and maintenance of both the InCharge Health and the HU Toolbox apps using the RE-AIM framework, and qualitatively evaluate the implementation of both mHealth interventions. RESULTS The study is currently enrolling study participants. Recruitment is anticipated to be complete by mid-2021. CONCLUSIONS If this two-level intervention, the combined use of InCharge Health and HU Toolbox apps, demonstrates efficacy in increasing adherence to hydroxyurea and prescribing behavior in patients with SCD and their providers, respectively, both apps will be offered to other institutions outside the SCDIC through a future larger implementation-effectiveness study. CLINICALTRIAL Clinicaltrails.gov, NCT04080167, September 6, 2019 https://clinicaltrials.gov/ct2/show/NCT04080167
BACKGROUND Hydroxyurea therapy prevents disease complications among patients with sickle cell disease (SCD). Despite the evidence for its efficacy and endorsement by the National Health Lung and Blood Institute (NHLBI) evidence-based guidelines, adoption of this therapy is low, both by patients with SCD and their providers. Mobile health (mHealth) applications provide benefit in improving medication adherence and self-efficacy among patients with chronic diseases and have facilitated prescribing among medical providers. However, mHealth has not been systematically tested as a tool to increase hydroxyurea adherence, nor has the combination of mHealth been assessed at both patient and provider levels to increase hydroxyurea utilization. OBJECTIVE To increase hydroxyurea utilization through a combined two-level mHealth intervention approach for both patients with SCD and their providers. The goals are to increase adherence to hydroxyurea therapy among patients with SCD and improve hydroxyurea prescribing behavior among providers of patients with SCD. METHODS We will test the efficacy of two mHealth interventions to increase both patients’ and providers’ utilization and knowledge of hydroxyurea within eight clinical sites of the NHLBI-funded Sickle Cell Disease Implementation Consortium (SCDIC). The patient mHealth intervention, InCharge Health, includes multiple components that addresses memory, motivation, and knowledge barriers to hydroxyurea use. The provider mHealth intervention, Hydroxyurea Toolbox (HU Toolbox) addresses the clinical knowledge barriers in prescribing and monitoring hydroxyurea. The primary hypothesis is that among adolescents and adults with SCD, adherence to hydroxyurea, as measured by the proportion of days covered (the ratio of the number of days the patient is covered by the medication to the number of days in the treatment period), will increase by at least 20% after 24 weeks of receiving the InCharge Health app, compared to their adherence at baseline. As secondary objectives, we will 1) examine the change in health-related quality of life, acute disease complications, perceived health literacy and perceived self-efficacy in taking hydroxyurea among patients who use InCharge Health, and 2) examine potential increases in the awareness of hydroxyurea benefits and risks, appropriate prescribing, and perceived self-efficacy to correctly administer hydroxyurea therapy among SCD providers between baseline and 9 months of using the HU Toolbox app. We will measure the reach, adoption, implementation, and maintenance of both the InCharge Health and the HU Toolbox apps using the RE-AIM framework, and qualitatively evaluate the implementation of both mHealth interventions. RESULTS The study is currently enrolling study participants. Recruitment is anticipated to be complete by mid-2021. CONCLUSIONS If this two-level intervention, the combined use of InCharge Health and HU Toolbox apps, demonstrates efficacy in increasing adherence to hydroxyurea and prescribing behavior in patients with SCD and their providers, respectively, both apps will be offered to other institutions outside the SCDIC through a future larger implementation-effectiveness study. CLINICALTRIAL Clinicaltrails.gov, NCT04080167, September 6, 2019 https://clinicaltrials.gov/ct2/show/NCT04080167
Background: Sickle cell disease is one of the oldest genetic disorders known to medical science. The morbidity and mortality associated with the disease and its complication, sickle cell crisis, amounts to be a significant health issue. Hydroxyurea, originally used as an anticancer agent, has proved to be the wonder drug in lower doeses in sickle cell diease. The severity and impact of the disease on the affected person is decreased by a great extent by its use. The mechanism of action of the drug in sickle cell disease is yet to be completely understood. Electrolytes play a crucial role in the pathophysiology of sickle cell disease. Aim: The current study aims to evaluate the serum electrolyte levels in sickle cell disease patients and look for the effect of hydroxyurea on them. Materials and methods: Fifty two sickle cell disease (SS) patients and 20 normal individuals were included in the study (AA). Thirty four of the SS patients were under hydroxyurea therapy. The serum levels of magnesium, sodium, potassium, chloride, calcium, phosphate were estimated in all the study subjects. Results and discussion: No significant difference was found with respect to the serum electrolytes in the sickle cell patients under and not under hydroxyurea therapy. But the serum electrolytes varied significantly between the sickle cell disease patients and the normal individuals. Conclusion: Serum electrolytes play a crucial role in the pathophysiology of sickle cell disease, but hydroxyuera therapy does not seem to play a great role in altering their levels in the patients.
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