Identifying Opportunities to Improve Hydroxyurea Therapy Initiation and Adherence among Children with Sickle Cell Disease

Background
Severe pain episodes are the most common, debilitating, and costly morbidity of sickle cell disease (SCD). Use of hydroxyurea is the only method to prevent these pain crises among children, and interventions to increase its use are urgently needed. This project will identify of opportunities to develop targeted interventions to increase the use of hydroxyurea among this high-risk population.

Specific aims for this project are as follows:

  • Aim 1: Quantify hydroxyurea therapy prevalence prior to NHLBI guidelines, and changes in prevalence post-NHLBI guidelines among children with SCD using Medicaid administrative claims data, as well as predictors of hydroxyurea initiation and adherence.
  • Aim 2: Evaluate the comparative effectiveness of hydroxyurea therapy among adherent users on reducing the incidence of pain crises, adverse outcomes, and use of health services, compared with those having limited or no use of hydroxyurea therapy.
  • Aim 3: Identify barriers to initiation and adherence of hydroxyurea therapy through focus groups conducted among adolescents with SCD, caregivers of children with SCD, and SCD health services providers in Michigan.

Methods
This study proposes to use administrative claims from states with the highest prevalence of SCD and focus groups with key stakeholders in Michigan to identify multiple levels of opportunities for improvement in appropriate use of hydroxyurea therapy among children with SCD.

Implications
Given the substantial positive impact of hydroxyurea therapy on health outcomes, quality of life, and healthcare utilization, increasing its use is of the utmost importance in this high-risk population. The successful completion of this research project will identify high impact intervention targets to increase the use of hydroxyurea therapy among children with SCD. 

Funded by the National Heart Lung and Blood Institute

For more information, please contact:
Investigator: Sarah L. Reeves, PhD, MPH
University of Michigan Child Health Evaluation and Research (CHEAR) Center
300 North Ingalls, 6D19
Ann Arbor, MI 48109-5456
Telephone: (734) 615-8319 Fax: (734) 764-2599 Email: sleasure[at]umich[dot]edu