A systematic review of barriers and interventions to improve appropriate use of therapies for sickle cell disease.
Clinical experts have expressed concern about underutilization of sickle cell disease (SCD) therapies, including hydroxyurea, prophylactic antibiotics, iron chelation, bone marrow transplantation, pain management during vaso-occlusive crisis, and receipt of routine ambulatory health care. We synthesized studies that identified barriers to and interventions to improve appropriate use of these therapies. Of the 48 studies included in our review, 35 identified therapeutic barriers or facilitators, and 13 evaluated interventions to improve use of therapies. Consistently identified barriers to appropriate pain management were negative provider attitudes and lack of provider knowledge. Four of 9 pain management interventions improved direct measures of pain management quality, while 5 improved indirect measures. One intervention improved receipt of routine ambulatory care. We concluded that interventions to improve pain management in SCD can be effective and should address providers' negative attitudes and knowledge and that more intervention studies are needed to improve receipt of recommended SCD therapies.
Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Division of Hematology, 2024 E Monument St, Rm 2-521, Baltimore, MD 21287, USA.
Carlton
C
Haywood
Mary Catherine
MC
Beach
Sophie
S
Lanzkron
John J
JJ
Strouse
Renee
R
Wilson
Haeseong
H
Park
Catherine
C
Witkop
Eric B
EB
Bass
Jodi B
JB
Segal
D000755:Anemia, Sickle Cell / Q000188:drug therapy / Q000628:therapy*; D000986:Antisickling Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D018450:Disease Progression; D004363:Drug Utilization; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D059408:Pain Management; D010818:Practice Patterns, Physicians' / Q000592:standards*
D000986:Antisickling Agents