Improving Access to Hydroxyurea for Adults with Sickle Cell Disease

改善镰状细胞病成人患者获得羟基脲的机会

• 批准号: 8445712
• 负责人: SOPHIE M LANZKRON
• 金额: $ 35.56万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-05 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8445712
• 关键词: Accident and Emergency department; Address; Adherence; Adult; Attitude; Behavior Therapy; Clinic; Clinic Visits; Code; Communities; Consensus; Counseling; Data; Disease; Goals; Grant; Health; Hematologist; Hematology; Hospitalization; Hospitals; Improve Access; Inpatients; Intervention; Knowledge; Lead; Multicenter Trials; Multimedia; Nurses; Oncologist; Online Systems; Patient Noncompliance; Patients; Pharmacologic Substance; Pharmacy facility; Physicians; Preparation; Problem Solving; Protocols documentation; Provider; Randomized; Randomized Clinical Trials; Rare Diseases; Resources; Sickle Cell Anemia; Testing; Time; Toxic effect; Training; United States National Institutes of Health; Visit; abstracting; arm; base; compliance behavior; design; experience; hydroxyurea; improved; interest; multi-component intervention; oncology; patient population; primary outcome; public health relevance; randomized trial; sickling; therapy design; tool; treatment as usual

DESCRIPTION (provided by applicant): Our overall goal is to improve utilization of hydroxyurea for adults with sickle cell disease. Hydroxyurea (HU) therapy is currently the only disease-modifying pharmaceutical agent available to treat adult patients with sickle cell anemia (SCA). A recent NIH consensus panel reviewed the available evidence regarding HU treatment for SCD and found it to be safe, efficacious, and effective (Brawley et al., 2008). This review also found HU to be highly underutilized. We have previously identified provider barriers to the use of HU which included many concerns about patient compliance and concerns over toxicity. As SCD is a rare disorder, a large multistate study will be needed to test interventions to improve utilization of HU in this patient population. The design of this large trial will entail having hem/onc providers participate in a web based intervention to improve knowledge and decrease barriers to prescribing HU and then randomize their patients to an intervention to improve adherence. The primary aim of this large multicenter trial will be to demonstrate that the intervention decreases hospital and emergency room visits for adults with SCD eligible for HU. The purpose of this R34 grant is to gather data needed in order to do the larger study. With this grant we well characterize the patients seen by community hematologist/oncologists (Aim1), refine and test (Aim 2) a behavioral intervention designed to reduce the informational and attitudinal factors which contribute to hematologists/oncologists reluctance to prescribe HU to SCD patients and finally assess the feasibility (Aim 3) of training clinic staff to provide problem solving to patients to improve adherence to HU. Based on data from our previous studies on provider identified barriers to HU our central hypothesis is that lack of knowledge by hematologists/oncologists regarding the management of HU, as well a lack of appropriate tools to overcome barriers to its use, significantly contribute to the underutilization of HU.

描述（由申请人提供）： 我们的总体目标是改善镰状细胞疾病成年人的羟基脲的利用。目前，羟基脲（HU）治疗是可用于治疗成年患者镰状细胞贫血（SCA）的唯一疾病改良药物。 NIH最近的共识小组回顾了有关HU治疗SCD的可用证据，发现它是安全，有效和有效的（Brawley等，2008）。这篇评论还发现，胡高度未被充分利用。我们以前已经确定了使用HU的提供者障碍，其中包括许多对患者依从性和对毒性的担忧的担忧。由于SCD是一种罕见的疾病，因此需要进行大型多阶段研究来测试干预措施以改善该患者人群的HU利用率。这项大型试验的设计将需要HEM/ONC提供商参加 在基于Web的干预措施中，以改善知识并减少开处方HU的障碍，然后将患者随机进行干预以提高依从性。这项大型多中心试验的主要目的是证明干预措施减少了有资格获得HU的成年人的医院和急诊室就诊。这项R34赠款的目的是收集所需的数据以进行更大的研究。有了这笔赠款，我们很好地表征了社区血液学家/肿瘤学家（AIM1），改进和测试（AIM 2）旨在减少旨在减少血液学家/肿瘤学家不愿开处方SCD患者HU处方的信息和态度因素的行为干预措施（AIM 2），并最终评估培训员工以改善问题的患者，以改善训练的患者，以改善训练的患者，以改善问题。基于我们先前关于提供者的研究的数据，我们的中心假设是血液学家/肿瘤学家缺乏知识的知识，以及缺乏克服其使用障碍的适当工具，这显着导致了HU的不足。