Psychosocial risk and health care utilization in pediatric sickle cell disease

Abstract

Introduction: Pain and complications related to pediatric sickle cell disease (SCD) are associated with higher health care utilization. In other pediatric chronic conditions, psychosocial screening can help identify children and families at risk of increased health care utilization to guide resource allocation, address treatment needs, and improve care. This study aimed to investigate the utility of psychosocial screening in predicting increased health care utilization among youth with SCD.Methods: Youth with SCD (n = 74, 8-18 years) and their parents were recruited from comprehensive SCD clinics. Parents completed the Psychosocial Assessment Tool (PAT), which categorized family psychosocial risk into one of three categories: Universal (minimal distress), Targeted (elevated distress), and Clinical (persistent distress).Youth reported on their pain characteristics, and health care utilization was extracted from medical chart review. Differences in health care utilization were evaluated using analysis of variance (ANOVA) and moderation analyses.Results: Based on PAT risk, families were categorized into Universal (56.8%), Targeted (29.7%), and Clinical (13.5%) risk groups, with no significant group differences across demographic variables. Patients in the Targeted group reported significantly higher pain frequency than those in the Universal group (F[2, 66] = 3.7, p < .05). The association between pain frequency and health care utilization significantly varied on the basis of psychosocial risk, such that Clinical psychosocial risk strengthened the connection between pain frequency and health care utilization (β = .2, t = 2.1, p < .05). Conclusions:Integrating the PAT into routine clinical care may help health care providers identify families in need of greater psychosocial or medical support to further optimize SCD management.

Identifying Chronic Pain Subgroups in Pediatric Sickle Cell Disease

“…Cutoffs scores are used to categorize families based on their risk severity: (1) Universal (total score <1), indicates some distress and general resilience; (2) Targeted (total score ≥1 and <2), indicates acute distress and some preexisting risk factors; and (3) Clinical (total scores ≥2), indicates persistent distress and multiple psychosocial risk factors. Among families managing pediatric SCD, ∼50% fall in the Universal risk category, 36% into Targeted risk, and 14% tend to fall into Clinical risk 52,53. The PAT demonstrated strong test-retest reliability, moderate to strong internal consistency, and overall stable total risk scores over time among samples of youth with SCD 52,54,55…”

“…Among families managing pediatric SCD, ∼50% fall in the Universal risk category, 36% into Targeted risk, and 14% tend to fall into Clinical risk. 52,53 The PAT demonstrated strong test-retest reliability, moderate to strong internal consistency, and overall stable total risk scores over time among samples of youth with SCD. 52,54,55 Demographics, Clinical Characteristics, and Health Care Utilization Parents reported on child and parent age, sex, race, ethnicity, annual family income, as well as parent marital status, highest education level attainment, and history of parent's own SCD or chronic pain.…”

Burden of Aging: Health Outcomes Among Adolescents and Young Adults With Sickle Cell Disease

“…20 Previous research has found that among AYA with SCD, patients with elevated distress/depression reported significantly higher pain frequency than those with minimal distress/ depression. 21,22 Poor sleep has also been linked to worsened depression. 22,23 The current study confirmed these associations between pain frequency, depression, and sleep.…”

Comment on: Psychosocial risk and health care utilization in pediatric sickle cell disease

“…To the editor, The article "Psychosocial risk and health care utilization in pediatric sickle cell disease" by Kerri E. Woodward et al 1 was read with utmost seriousness and deep curiosity. It was enjoyable to go through the well-concisely written and straightforward prose and we appreciate the authors for their remarkable efforts.…”