Sickle cell disease pain management and the medical home

Raphael, Jean L.; Oyeku, Suzette O.

doi:10.1182/asheducation-2013.1.433

Cited by 16 publications

(14 citation statements)

References 42 publications

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“…Prior studies in patients with SCD have described the benefits of a day hospital [10,13] and/or comprehensive models of care [14]. In this study, the day hospital likely contributed to the lower rate of admission post-intervention, but does not entirely account for the size of the drop in admissions within the super-utilizing group.…”

Section: Discussionmentioning

confidence: 80%

Intensive management of high‐utilizing adults with sickle cell disease lowers admissions

et al. 2015

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A minority of super-utilizing adults with sickle cell disease (SCD) account for a disproportionate number of emergency department (ED) and hospital admissions. We performed a retrospective cohort study comparing the rate of admission before and after the opening of a clinic for adults with SCD. Unique to this clinic was an intensive management strategy, focusing on super-utilizing adults with 12 or more admissions per year. ED/hospital and 30 days re-admission rates were compared, 1 year pre-and post-intervention, for those adults who established in the clinic. Prior to the intervention, 17 super-utilizers, comprising 15% of the preintervention cohort (n 5 115), accounted for 58% of the total admissions and had an admission rate of 28 per patient-year. When pre-and post-intervention years were compared, rate of ED/hospital admission per patient-year for super-utilizers decreased from 27.9 to 13.5 (P < 0.001), while there was not a significant reduction for the entire cohort (7.1 vs. 6.1, P 5 0.84). Similarly, the decrease in rate of 30 day re-admission was larger for the super-utilizers (13.5 per patient-year to 1.8, P < 0.001), than the whole cohort (2.6 per patient-year to 0.7, P 5 0.006). Among the super-utilizers, the reduced rate of admission from the pre-to post-clinic intervention year equated to 252 fewer ED/hospital admissions and 227 fewer 30 day readmissions. This management strategy focusing on super-utilizing adults with SCD lowered admission and 30 day re-admission rate.

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Section: Discussionmentioning

confidence: 80%

Intensive management of high‐utilizing adults with sickle cell disease lowers admissions

et al. 2015

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“…Sociologically, the implication of these findings is that the Nigerian society is not yet ready to tackle the problem of sickle cell disease [12,13]. Also, the traditional society's view of anybody that is disabled or incapacitated as useless may be a factor in the neglect of people living with sickle cell disease in the country [14].…”

Section: The Health Workers Definition Of Sickle Cell Disease and Manmentioning

confidence: 99%

The Health Workers Perspectives in the Management of Sickle Cell Disease in an Urban Health Centre in Ile-Ife, Nigeria

Muoghalu¹,

Awolowo²

2017

J Hematol Thrombo Dis

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Management of sickle cell disease is key to improved quality of life of people living with the disease in Nigeria. This paper examined management strategies utilized by health workers in managing sickle cell patients in Obafemi Awolowo University health centre, in Ile-Ife, Nigeria. The specific objectives were to explore health workers definition of the disease, the observed symptoms by the health workers, drugs and non-drug strategies employed by these health workers in the management of the patients and the adequacy of health facilities for managing sickle cell patients. With structured in-depth interview schedule, fifteen health workers including nurses and doctors were interviewed. It was indicated that unanimously, health workers defined the disease as an inherited blood disorder which is highly symptomatic with a lot pains all over the body especially in joints and chest and that the sufferers are often admitted in the hospital. Also, the health workers use antibiotics, folic acid, analgesics, anti-malaria drugs, intravenous fluids and blood transfusion as drug regimens for managing the sufferers. The non-drug strategies employed by the health workers were counselling, education for self-care and psychotherapy. Furthermore, the health workers indicated that inadequate health facilities hamper their capacity to deliver effective management to people living with the disease. The paper concludes that health workers employ both drug and non-drug management strategies that promise improved quality of life for sickle cell patients in Nigeria but are constrained by inadequate health facilities and consumables.

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“…Readers are referred to excellent reviews on the pathophysiology of, and novel therapies for, SCD-related pain. [31][32][33] Prevention of recurrent or chronic pain. Kalff et al evaluated the impact of a chronic erythrocytapheresis program on the incidence and types of acute and chronic complications of SCD and transfusions in 12 adult patients with various complications of SCD.…”

Section: Category III Indications Vaso-occlusive Painmentioning

confidence: 99%

Red cell exchange: special focus on sickle cell disease

Kim

2014

Hematology

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The primary function of red blood cells (RBCs) is to deliver oxygen from the lungs to tissues. Tissue hypoxia occurs when the oxygen-carrying capacity of RBCs is compromised due primarily to 3 causes: (1) a reduction in circulating RBC mass, (2) an increase in circulating RBC mass, or (3) abnormal hemoglobin (Hb) that either does not sufficiently release oxygen to tissues (high-oxygen-affinity hemoglobin) or occludes the microvasculature due to deformed RBCs (sickled RBCs). To improve oxygenation in patients with reduced or increased RBC mass, RBC administration (simple transfusion) or RBC removal (RBC depletion) is performed, respectively. However, for patients with abnormal Hb, RBCs containing abnormal Hb are removed and replaced by healthy volunteer donor RBCs by red cell exchange (RCE). RCE can be performed by manual exchange or by automated exchange using a blood cell separator (erythrocytapheresis). In this review, indications for RCE in sickle cell disease using the evidence-based American Society for Apheresis categories 1 are presented and the rationale for RCE in each disorder are discussed. Simple transfusion versus RCE and manual RCE versus automated RCE are compared. Finally, this review briefly presents some of the challenges of performing erythrocytapheresis in small children and discusses various choices for central venous access during RCE. 2 Learning Objectives• To describe indications for RCE • To define goals for RCE for stroke prophylaxis in sickle cell disease • To discuss benefits versus risks of automated RCE compared with simple transfusion and manual RCE.

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Sickle cell disease pain management and the medical home

Cited by 16 publications

References 42 publications

Intensive management of high‐utilizing adults with sickle cell disease lowers admissions

Intensive management of high‐utilizing adults with sickle cell disease lowers admissions

The Health Workers Perspectives in the Management of Sickle Cell Disease in an Urban Health Centre in Ile-Ife, Nigeria

Red cell exchange: special focus on sickle cell disease

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