A systematic review of barriers and interventions to improve appropriate use of therapies for sickle cell disease

Carlton Haywood, Mary Catherine Beach, Sophie Lanzkron, John J. Strouse, Renee Wilson, Haeseong Park, Catherine Witkop, Eric B. Bass, Jodi B. Segal

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

Clinical experts have expressed concern about underutilization of sickle cell disease (SCD) therapies, including hydroxyurea, prophylactic antibiotics, iron chelation, bone marrow transplantation, pain management during vaso-occlusive crisis, and receipt of routine ambulatory health care. We synthesized studies that identified barriers to and interventions to improve appropriate use of these therapies. Of the 48 studies included in our review, 35 identified therapeutic barriers or facilitators, and 13 evaluated interventions to improve use of therapies. Consistently identified barriers to appropriate pain management were negative provider attitudes and lack of provider knowledge. Four of 9 pain management interventions improved direct measures of pain management quality, while 5 improved indirect measures. One intervention improved receipt of routine ambulatory care. We concluded that interventions to improve pain management in SCD can be effective and should address providers' negative attitudes and knowledge and that more intervention studies are needed to improve receipt of recommended SCD therapies.

Original languageEnglish
Pages (from-to)1022-1033
Number of pages12
JournalJournal of the National Medical Association
Volume101
Issue number10
DOIs
StatePublished - Oct 2009
Externally publishedYes

Keywords

  • Health care
  • Patient-physician relationship
  • Sickle cell anemia
  • Treatment

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