Modifying factors of the health belief model associated with missed clinic appointments among individuals with sickle cell disease

Cronin, Robert M.; Hankins, Jane S.; Byrd, Jeannie; Pernell, Brandi; Kassim, Adetola A.; Adams-Graves, Patricia; Thompson, Alexis A.; Kalinyak, Karen; DeBaun, Michael R.; Treadwell, Marsha

doi:10.1080/10245332.2018.1457200

Cited by 24 publications

(24 citation statements)

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“…This includes nonhematology specialists visits, before ED and hospitalizations for common complaints such as pain, as this is the most common reason for SCD patient hospitalization, is complex and difficult to manage. 35,36,49,50 These findings support the need for alternative care models. However, models such as the patient-centered medical home (PCMH) care model have been difficult to implement and for patients to access.…”

Section: Ed Encounters and Hospitalizationmentioning

confidence: 52%

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

et al. 2020

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Background: Sickle-cell disease (SCD) causes significant morbidity, premature mortality, and high disease burden, resulting in frequent health care use. Comanagement 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 comanagement, and adherence to Hydroxyurea.Methods: Data from 2790 patients diagnosed with SCD, age 1 to 65؉ years, enrolled at least 1 month in North Carolina Medicaid between March 2016 and February 2017, were analyzed. Outpatient visits were categorized as primary care, hematologist, and nonhematologist specialist. Nurse practitioners or physician assistants with unidentified specialty type or family practice were categorized separately. Comanagement was defined as a minimum of 1 primary care and 1 hematologist visit/patient during the study period.Results: There were notable age-related differences in utilization of health care services. Only 34.82% of the sample was comanaged. Comanagement was higher in the 1-to-9-year-old (44.88%) and 10-to-17-year-old groups (39.22%) versus the 31-to-45-year-old (30.26%) and 65؉-year-old (18.75%) age groups. Age had the greatest influence (AUC ‫؍‬ 0.599) on whether or not a patient was comanaged. Only a third of the sample (32.24%) had at least 1 Hydroxyurea (HU) prescription. Age was the most predictive factor of good HUadherence (AUC ‫؍‬ 0.6503). Prediction by comanagement was minimal with an AUC ‫؍‬ 0.5615.Conclusion : Comanagement was a factor in predicting HUadherence, but further studies are needed to identify the frequency and components of comanagement needed to increase adherence and reduce acute care utilization. (J Am Board Fam Med 2020;33:91-105.)Sickle-cell disease (SCD) is a genetic disorder and the most common rare blood disease in the United States. 1 Patients suffer from complications, includ-ing but not limited to stroke, acute chest syndrome, and severe painful crisis that contributes to morbidity and premature mortality. Individuals also suffer from significant disease burden, often resulting in a high number of hospitalizations, readmissions, emergency department (ED) visits, and other associated costs to the health care system. In 2006 people with SCD had an estimated 232,382 ED visits, 68,410 hospitalizations from the ED, accounting for an estimated $2.4 billion dollars. 2 In 2010, SCD was associated with the highest 30-day readmission rate (31.9%) among all diagnoses excluding cancer and cancer-related conditions. 3 Other national data representing about 1 ⁄3 of the SCD population found a similar 30-day readmis-This article was externally peer reviewed.

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Section: Ed Encounters and Hospitalizationmentioning

confidence: 52%

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

et al. 2020

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“…Appointments are a very important component of care in SCD, as lack of outpatient follow up and access to primary care providers (PCPs) have been implicated in more hospitalizations [13,14,15]. In related work, we demonstrated multiple risk factors for missed appointments, which could be targeted to improve attendance at clinic appointments and help decrease hospitalizations [29]. Missed appointments were not significantly associated with hospitalizations and readmissions in children as reported by caregivers, which could be related to the smaller sample size of readmitted children, different reasons for hospitalizations, children having fewer complications than adults, or the larger role PCPs play in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for hospitalizations and readmissions among individuals with sickle cell disease: results of a U.S. survey study

et al. 2018

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Objective: Hospital admissions are significant events in the care of individuals with sickle cell disease (SCD) due to associated costs and potential for quality of life compromise. Methods: This cross-sectional cohort study evaluated risk factors for admissions and readmissions between October 2014 and March 2016 in adults with SCD (n = 201) and caregivers of children with SCD (n = 330) at six centres across the U.S. Survey items assessed social determinants of health (e.g. educational attainment, difficulty paying bills), depressive symptoms, social support, health literacy, spirituality, missed clinic appointments, and outcomes hospital admissions and 30-day readmissions in the previous year. Results: A majority of adults (64%) and almost half of children (reported by caregivers: 43%) were admitted, and fewer readmitted (adults: 28%; children: 9%). The most common reason for hospitalization was uncontrolled pain (admission: adults: 84%, children: 69%; readmissions: adults: 83%, children: 69%). Children were less likely to have admissions/readmissions than adults (Admissions: OR: 0.35, 95% CI: [0.23,0.52]); Readmissions: 0.23 [0.13,0.41]). For all participants, missing appointments were associated with admissions (1.66 [1.07, 2.58]) and readmissions (2.68 [1.28, 6.29]), as were depressive symptoms (admissions: 1.36 [1.16,1.59]; readmissions: 1.24 [1.04, 1.49]). In adults, difficulty paying bills was associated with more admissions, (3.11 [1.47,6.62]) readmissions (3.7 [1.76,7.79]), and higher spirituality was associated with fewer readmissions (0.39 [0.18,0.81]). Discussion: Missing appointments was significantly associated with admissions and readmissions. Findings confirm that age, mental health, financial insecurity, spirituality, and clinic attendance are all modifiable factors that are associated with admissions and readmissions; addressing them could reduce hospitalizations.

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“…A Pearson correlation test examined the relationship between potential covariates (child age, child gender, SCD genotype, family income, and caregiver education) and percent nonattendance. These potential covariates were determined based off previous literature in pediatric clinic attendance (Paterson et al, 2010;Cronin, et al, 2018;Shaffer et al, 2016;Schlenz et al, 2016).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Previous literature has demonstrated spirituality, social support, and literacy as protective factors for clinic attendance. Meanwhile, risk factors for clinic non-attendance in SCD include financial insecurity, cognitive impairment, and depression (Cronin et al, 2018). Effective caregiver coping has the potential to address some of these protective and risk factors and improve clinic attendance in pediatric SCD patients.…”

Section: Introductionmentioning

confidence: 99%

Examining Caregiver Coping and Clinic Attendance in Pediatric Sickle Cell Disease

Evans

2020

UFJUR

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Sickle Cell Disease (SCD), the most common genetic disorder in the U.S., primarily affects youth of African or Latino backgrounds. Regular clinic attendance promotes positive health outcomes in pediatric SCD. Caregivers of youth with SCD endorse high levels of stress that may disrupt clinic attendance. Improved caregiver coping may help address barriers to clinic attendance in SCD families. Sixty-three caregivers and youth (Mage = 13.2, 60.3% male) completed the Responses to Stress Questionnaire- Sickle Cell Disease (RSQ-SC). The RSQ-SC assesses primary control engagement (PCE), secondary control engagement (SCE), and disengagement coping. The researchers tabulated percent of pediatric hematology appointments attended, canceled by patient/provider/due to hospitalization, and no-showed over the past year via medical chart review. Results indicated a significant positive association between caregiver education and percentage of appointments attended (r = .295, p = 0.19). A hierarchical regression revealed that caregiver coping did not predict clinic attendance [F (4, 58) = 2.114, p = 0.091, R2 Δ = 0.040] when controlling for caregiver education. In isolation, caregiver coping may not be an effective target for interventions focused on improving adherence to pediatric hematology appointments.

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Modifying factors of the health belief model associated with missed clinic appointments among individuals with sickle cell disease

Cited by 24 publications

References 40 publications

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

Risk factors for hospitalizations and readmissions among individuals with sickle cell disease: results of a U.S. survey study

Examining Caregiver Coping and Clinic Attendance in Pediatric Sickle Cell Disease

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