Chapter 2: Organisation of care "We require respect, care, dignity and candour. We require mandated standards that can be challenged by patients when failures occur. Commissioning that reflects need that has parity with other specialised illnesses given SCD is the world's most common genetic condition."
General principles"We need more nurses, more community services, more adult care support services and a dedicated team to support us with the phases of change we experience as sickle patients."
Community nursing"More home visits should be encouraged by support workers and nurses" "My community specialist nurse gave me a card which I carry in my wallet and shows I am on the national haemoglobinopathy registry and has all my medical details at hand in case of an emergency"
Prevention of infection: immunisations and prophylactic antibiotics"The penicillin and folic acid helps me. The six monthly clinic at the hospital is usually for blood tests and checks. I have not been in hospital with a crisis for nearly two years.""I get my pneumococcal vaccines every five years and my flu jabs yearly. I don't tend to have chest infections lately"
Blood pressure monitoring"My blood pressure is always monitored when I attend my outpatient appointments. However, this is not very regular."
Recommendations Hypertension in SCD should be monitored and treated in primary care. Patients with hypertension and ACR <3.5 mg/mmol should be treated with a BP target of <140/90 mmHg. Patients with hypertension and ACR ≥3.5 mg/mmol should be treated with a BP target of <130/80 mmHg. In the absence of proteinuria initial treatment should be with calcium channel blockers.
Folic acid"I have been taking folic acid since I was a child, I am now in my 40s"
Nutrition and lifestyle"We could do with some help with food management and what not to eat e.g. foods with iron if you are on an exchange programme." "I have been fortunate enough to have a research background, so I have researched myself treatments, management and why I need to eat certain foods etc."
Health education'… the competencies that 'lay' contributors can offer should not be permitted to draw attention away from the need to change professional attitudes and practices, and the value of constructive, 'grown up ', professional/patient relationships.'