Predictors of acute care utilization and acute pain treatment outcomes in adults with sickle cell disease: The role of non‐hematologic characteristics and baseline chronic opioid dose

Abstract

Despite its rarity in the United States, sickle cell disease accounts for a disproportionate amount of healthcare utilization and costs. The majority of this is due to acute care for painful crises. A small subpopulation of patients accounts for most these costs due to frequent visits to emergency departments and acute care facilities. Previous investigations have found that these high utilizing patients are distinguished by both a more severe disease course and certain non-hematologic characteristics, which may include higher socioeconomic status and some psychiatric and psychological characteristics. This prospective observational cohort study was undertaken to test the ability of these characteristics to prospectively predict acute pain care outcomes, including visit frequency, total opioid doses, and pain improvement at the Johns Hopkins Sickle Cell Infusion Center (SCIC). Seventy-three participants were followed for 12 months and SCIC utilization and treatment outcomes were tabulated for 378 visits. Participants who visited the SCIC most frequently had markedly worse pain improvement despite higher within-visit opioid doses. Higher utilization was associated with indicators of greater illness severity, more aggressive treatment for sickle cell disease, higher baseline opioid doses, higher socioeconomic status, greater pain-related anxiety, and a history of psychiatric treatment. Overall, poor acute pain treatment response was associated with higher utilization and higher baseline opioid doses. The pattern of association between high utilization, poor acute care outcomes, and higher baseline opioid doses is discussed in terms of prior research and future directions.

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

“…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.…”

The association of psychiatric comorbidities with emergency visits and hospitalisations in adult sickle‐cell patients: a cohort study

“…The global emergency care consumption of SCD patients and the ratio of ED consultations followed by hospitalisation found here are consistent with previous studies (Brousseau et al , ; Paulukonis et al , ; Carroll et al , ). A meta‐analysis found a 2·8 relative risk of high hospital utilisation in SCD patients with depression (Jonassaint et al , ).…”

The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review

“…In people having pain symptoms, analyses for symptom-related anxiety symptoms showed a consistent positive relationship with the amount of consultations with healthcare providers based on univariate analyses (10 analyses reporting a positive association [60,72,92,103,113] and 1 no association [95]-91% agreement), while in multivariate analyses inconsistent results for this association were found (8 analyses reporting a positive association [60,71,72,95,103,113,120] and 8 no association [50,60,71,72,120]-50%).…”