Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use.
Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use.
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DOI：
10.3122/jabfm.2020.01.190143
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发表时间：
2020-01
期刊：
影响因子：
--
通讯作者：
Shah N
中科院分区：
文献类型：
--
作者：
Crego N;Douglas C;Bonnabeau E;Earls M;Eason K;Merwin E;Rains G;Tanabe P;Shah N
镰状细胞病（SCD）导致显著的发病率、过早死亡率和高疾病负担，导致频繁的医疗保健使用。联合治疗可提高治疗的利用率和患者对治疗（如羟基脲）的依从性。本研究的目的是描述参加医疗补助的SCD患者的急性护理利用率，与联合管理和对羟基脲的依从性相关的患者因素。分析了2016年3月至2017年2月期间在北卡罗来纳州医疗补助计划中至少入组1个月的2，790例诊断为SCD的患者的数据，年龄为1至65岁以上。门诊访视分类为：初级保健、血液学家和非血液学家专家。未确定专业类型或家庭执业的执业护士或医师助理被单独分类。共同管理定义为研究期间每例患者至少接受一次初级保健和一次血液学家访视。医疗保健服务利用存在显着的年龄相关差异。只有34.82%的样本是共同管理的。与31-45岁（30.26%）和65岁以上（18.75%）年龄组相比，1-9岁（44.88%）和10-17岁（39.22%）年龄组的共同管理率较高。年龄对患者是否接受联合治疗的影响最大（AUC=0.599）。只有三分之一的样本（32.24%）至少有一种羟基脲处方。年龄是最能预测羟基脲良好依从性的因素（AUC 0.6503）。联合管理的预测值最小，AUC=0.5615。共同管理是预测羟基脲依从性的一个因素，但需要进一步研究来确定增加依从性和减少急性护理利用所需的共同管理的频率和组成部分。
Sickle cell disease (SCD) causes significant morbidity, pre-mature mortality and high disease burden, resulting in frequent healthcare use. Co-management may improve utilization and patient adherence with treatments such as Hydroxyurea. The purpose of this study was to describe acute care utilization in Medicaid enrolled patients with SCD, patient factors associated with co-management and adherence to Hydroxyurea. Data from 2,790 patients diagnosed with SCD, age 1 to 65+, enrolled at least 1 month in North Carolina Medicaid between March 2016 and February 2017 were analyzed. Out-patient visits were categorized as: primary care, hematologist and non-hematologist specialist. Nurse practitioners or physician assistants with unidentified specialty type or family practice were categorized separately. Co-management was defined as a minimum of one primary care and one hematologist visit/patient during the study period. There were notable age related differences in utilization of health care services. Only 34.82% of the sample was co-managed. Co-management was higher in the 1-9 (44.88%) and 10-17 year-old groups (39.22%) versus the 31-45 (30.26%) and 65+ (18.75%) age groups. Age had the greatest influence (AUC=0.599) on whether or not a patient was co-managed. Only a third of the sample (32.24%) had at least one Hydroxyurea prescription. Age was the most predictive factor of good Hydroxyurea adherence (AUC 0.6503). Prediction by co-management was minimal with an AUC=0.5615. Co-management was a factor in predicting Hydroxyurea adherence, but further studies are needed to identify the frequency and components of co-management needed to increase adherence and reduce acute care utilization.
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