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Targeted Education Program Improves Hydroxyurea Use in Sickle Cell Anemia

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After a sickle cell anemia (SCA) complication resulting in an emergency department (ED) visit, participation in a clinic that provides education on starting hydroxyurea increases the use of this agent, according to an observational cohort study. The educational clinic, dubbed the Quick-Start Hydroxyurea Initiation Project (Q-SHIP), included a hematologist-led discussion on hydroxyurea, a video of patients discussing hydroxyurea, and a direct offer to start hydroxyurea.

Over 64 weeks, 112 patients presented to the ED with an SCA complication, with 59% (n=66) participating in a Q-SHIP session a median of 6 days after their ED visit or hospital discharge. Overall, 55% of Q-SHIP participants (n=36) started hydroxyurea, with 83% (n=30) still on hydroxyurea after a median follow-up of 49 weeks. Laboratory markers of hydroxyurea adherence were found to be significantly increased from baseline. Comparing Q-SHIP participants to nonparticipants, 12 weeks after their ED visit, participants were more likely to have started hydroxyurea than nonparticipants (53% vs 20%, P=.0004) and to be taking hydroxyurea at last follow-up (50% vs 20%, P=.001). Two years after the implementation of Q-SHIP initiative, the investigators found that the overall proportion of eligible patients on hydroxyurea presenting to their ED increased from 56% to 80% (P=.0069).

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Pecker LH, Kappa S, Greenfest A, Darbari DS, Nickel RS. Targeted hydroxyurea education after an emergency department visit increases hydroxyurea use in children with sickle cell anemia. J Pediatr. 2018 Oct;201:221-228.e16. doi: 10.1016/j.jpeds.2018.05.019.

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