Original Communications
A Systematic Review of Barriers and Interventions to Improve Appropriate Use of Therapies for Sickle Cell Disease

https://doi.org/10.1016/S0027-9684(15)31069-5Get rights and content

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.

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    Funding/Support: This project was funded under contract 290-02-0018 from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services. Mr Haywood’s effort was supported by a National Research Service Award from the National Heart, Lung, and Blood Institute (5F31HL082037-03). Dr Beach’s effort was supported by K08-HS13903 from AHRQ.

    Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by AHRQ; the National Heart, Lung, & Blood Institute; or the US Department of Health and Human Services.

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