Hydroxyurea Use After Transitions of Care Among Young Adults With Sickle Cell Disease and Tennessee Medicaid Insurance

Mathias, Joacy G.; Nolan, Vikki G.; Klesges, Lisa M.; Badawy, Sherif M.; Hankins, Jane S.; Smeltzer, Matthew

doi:10.1001/jamanetworkopen.2021.28971

Cited by 9 publications

(10 citation statements)

References 8 publications

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“…Our needs assessment focused on care redesign to improve hydroxyurea uptake and considered intervention targets, modalities, and strategy mechanisms. Barriers and enablers to hydroxyurea utilization in the SCD population were conducted through literature synthesis (19)(20)(21)(22), populationlevel claims analysis (13,23), patient and provider surveys (24,25), semi-structured interviews, and focus groups (16, 26). To synthesize and organize the needs assessment findings at the patient level, the Health Belief Model (HBM) (27) was used, and the Social Cognitive Theory (SCT) was used as the behavioral change model (28).…”

Section: Activity 1: Needs Assessment Of Hydroxyurea Utilizationmentioning

confidence: 99%

“…As the first FDA-approved evidence-based drug for SCD, daily oral hydroxyurea is a medication recommended by guidelines (6) and with robust evidence for reducing acute and chronic disease complications, lowering acute-care utilization, and improving survival among individuals with SCD (7)(8)(9)(10)(11). In the U.S., <50% of patients with SCD appropriately utilize hydroxyurea (12)(13)(14)(15), severely limiting its population impact. SCDIC consortium members thus chose to focus on strategies to increase hydroxyurea uptake.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease

Hankins

Potter²,

Fernandez³

et al. 2023

Front. Health Serv.

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BackgroundSickle Cell Disease (SCD) is a progressive genetic disease that causes organ damage and reduces longevity. Hydroxyurea is an underutilized evidence-based medication that reduces complications and improves survival in SCD. In a multi-site clinical trial, part of the NIH-funded Sickle Cell Disease Implementation Consortium (SCDIC), we evaluate the implementation of a multi-level and multi-component mobile health (mHealth) patient and provider intervention to target the determinants and context of low hydroxyurea use. Given the complexity of the intervention and contextual variability in its implementation, we combined different behavioral and implementation theories, models, and frameworks to facilitate the evaluation of the intervention implementation. In this report, we describe engagement with stakeholders, planning of the implementation process, and final analytical plan to evaluate the implementation outcomes.MethodsDuring 19 meetings, a 16-member multidisciplinary SCDIC implementation team created, conceived, and implemented a project that utilized Intervention Mapping to guide designing an intervention and its evaluation plan. The process included five steps: (1) needs assessment of low hydroxyurea utilization, (2) conceptual framework development, (3) intervention design process, (4) selection of models and frameworks, and (5) designing evaluation of the intervention implementation.ResultsBehavioral theories guided the needs assessment and the design of the multi-level mHealth intervention. In designing the evaluation approach, we combined two implementation frameworks to best account for the contextual complexity at the organizational, provider, and patient levels: (1) the Consolidated Framework for Implementation Research (CFIR) that details barriers and facilitators to implementing the mHealth intervention at multiple levels (users, organization, intervention characteristics, broader community), and (2) the Technology Acceptance Model (TAM), a conceptual model specific for explaining the intent to use new information technology (including mHealth). The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework was used to measure the outcomes.DiscussionOur research project can serve as a case study of a potential approach to combining different models/frameworks to help organize and plan the evaluation of interventions to increase medication adherence. The description of our process may serve as a blueprint for future studies developing and testing new strategies to foster evidence-based treatments for individuals living with SCD.

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Section: Activity 1: Needs Assessment Of Hydroxyurea Utilizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease

Hankins

Potter²,

Fernandez³

et al. 2023

Front. Health Serv.

View full text Add to dashboard Cite

show abstract

“…Knowledge about hydroxyurea 12 (25) Knowledge about hydroxyurea regimen 6 (13) Forgetfulness 13 (27) Get my child to take their hydroxyurea 10 (21)…”

Section: Psychological Capability 18 (38)mentioning

confidence: 99%

“…22 Prior studies reported poor medication adherence to HU, penicillin, and asthma medications in SCD, 19,23,24 particularly among adolescents and young adults (AYA). 25 Previously reported barriers to adherence include forgetfulness, fear of side effects, inability to obtain refills, and misperceptions of SCD severity. 16,[26][27][28][29][30][31][32][33][34] Many of the previous studies focused on HU adherence included smaller sample sizes and did not examine adherence challenges using an established conceptual model.…”

Section: Introductionmentioning

confidence: 99%

“…Other studies suggested also potential clinical benefits of metformin in SCD 22 . Prior studies reported poor medication adherence to HU, penicillin, and asthma medications in SCD, 19,23,24 particularly among adolescents and young adults (AYA) 25 . Previously reported barriers to adherence include forgetfulness, fear of side effects, inability to obtain refills, and misperceptions of SCD severity 16,26–34 …”

Section: Introductionmentioning

confidence: 99%

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Barriers to medication adherence in sickle cell disease: A comprehensive theory‐based evaluation using the COM‐B model

King

Cai

Barrera

et al. 2023

Pediatric Blood & Cancer

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Background: Sickle cell disease (SCD) affects more than 100,000 Americans, with complications such as pain episodes and acute chest syndrome. Despite the efficacy of hydroxyurea in reducing these complications, adherence remains low. Study objectives were to examine barriers to hydroxyurea adherence, and to evaluate the relationship between barriers and their impact on adherence. Methods:In this cross-sectional study, patients with SCD and their caregivers were enrolled if they were taking hydroxyurea. Study measures included demographics, self-report of adherence using visual analog scale (VAS), and the Disease Management and Barriers Interview (DMI)-SCD. The DMI-SCD was mapped to the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Results:Forty-eight caregivers (females 83%, median age 38 [34][35][36][37][38][39][40][41][42][43]) and 19 patients (male 53%, median age 15 [13.5-18]) participated. Using VAS, many patients (63%) reported low hydroxyurea adherence, while most caregivers (75%) reported high adherence. Caregivers endorsed barriers across multiple COM-B components, with physical opportunity (e.g., cost) and reflective motivation (e.g., SCD perceptions) being the most identified categories (48% and 42%), respectively. Patients' most identified barriers included psychological capability (e.g., forgetfulness) and reflective motivation (84% and 68%), respectively. Patients' and caregivers' VAS scores negatively correlated with the number of barriers (r s = -.53, p = .01; r s = -.28, p = .05) and COM-B categories

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High hydroxyurea usage in sickle cell anemia regardless of patient demographics

Phan,

Park,

Dulman

et al. 2023

Pediatric Blood & Cancer

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Hydroxyurea is highly effective in sickle cell disease, but it is still underutilized. Reports of hydroxyurea utilization largely use Medicaid data, and socioeconomics is often cited as a barrier. To address whether patient demographics influenced the high hydroxyurea usage rate recently reported for the pediatric sickle cell program of Northern Virginia, analysis of data from 2011 to 2021 revealed no statistical difference in hydroxyurea usage rate between Medicaid and non‐Medicaid, African American and African, or age less than 13 and age greater than or equal to 13 years cohorts, demonstrating that hydroxyurea can be successfully implemented across demographic groups.

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Hydroxyurea Use After Transitions of Care Among Young Adults With Sickle Cell Disease and Tennessee Medicaid Insurance

Abstract: and Smeltzer reported receiving grants from the National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention during the conduct of the study. No other disclosures were reported.

Cited by 9 publications

References 8 publications

Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease

Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease

Barriers to medication adherence in sickle cell disease: A comprehensive theory‐based evaluation using the COM‐B model

High hydroxyurea usage in sickle cell anemia regardless of patient demographics

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