Sickle cell patients in rural areas may actually benefit from telemedicine practices and access to satellite clinics.
Findings from a new study show that telehealth had no negative effect on laboratory response to hydroxyurea in patients with sickle cell anemia (SCA).
The investigation, led by Sarah Shaner and colleagues at the University of Alabama at Birmingham, consisted of a retrospective chart review in patients of various locations and socio-economic statuses. In particular, the team sought to determine whether patients living in rural areas had effective and meaningful access to hydroxyurea.
“The UAB Pediatric Sickle Cell program’s satellite clinics reduce the barrier of transportation to the university-based clinic,” Shaner and colleagues explained. “However, as compared to the university clinic, these satellite clinics do not offer immediate access to hydroxyurea dosing laboratory results. Therefore, a nurse clinician calls families with hydroxyurea dose adjustments after the completion of the clinic visit.”
The 1-year retrospective review included 172 HbSS and HbSb0 thalassemia patients who were prescribed hydroxyurea during 2019. All patients were ≥18 years of age (mean age, 11) and received care in either the central academic center (n = 107) or satellite clinics (n = 65). The majority of the overall population (52.0%) was female.
Furthermore, the mean Hb of the population was 8.5±1.1g/dL, mean corpuscular volume (MCV) was 91.3±10.1 fL, HbF% was 12.7±6.7, and absolute neutrophil count (ANC ) was 4.9±2.3 x103/L. As for socio-economic status, the mean poverty level across communities was 18.1±4.2, and the median household income was $50,119±8,298.
Any patient with HbSD, HbSC, or Hb Sb+ thalassemia was excluded from the study, as were any patients who received a second sickle cell disease modifying therapy added to hydroxyurea.
The primary outcome sought by the investigators was percent fetal hemoglobin.
“We identified no significant differences in hydroxyurea monitoring laboratory values for Hb (P = 0.6), MCV (P = 0.7), HbF (P = 0.13), ANC (P = 0.9) by clinic location,” Shaner and team reported. “We did not identify a difference in all admissions to the hospital (P = 0.5) or pain admissions to the hospital (P = 0.6) between academic center vs. satellite clinic patients.
Nonetheless, patients who attended the academic center notably had a higher number of acute pain visits (P= .03). Even then, there were no differences in hospital admissions based on clinic location.
Although patients who attended the satellite clinics generally had worse socioeconomic indicators (lower poverty level and median household income, etc.), there were no observed associations between HbF levels and such indicators.
The only indicators that significantly impacted HbF—even within socioeconomic categories—were number of clinic visits and age.
“Our data shows similar hydroxyurea dosing and response to therapy utilizing a telehealth monitoring of laboratory values with phone call dose adjustments by a nurse clinician,” the investigators wrote. “Therefore, interventions to improve adherence to hydroxyurea in Alabama can be developed and tested in satellite clinics using telehealth hydroxyurea dose adjustments.”
Although the team acknowledged the study’s various limitations—including reliance on patient recall for hospitalizations and emergency department visits—they expressed optimism that telehealth practices can be useful for reaching sickle cell patients living in rural areas.
Even more, they noted that clinicians should not “consider the lack of immediate access to lab results a barrier to telehealth.”
The study, “Impact of Telehealth Visit and Socioeconomic Status (SES) on Hydroxyurea Response in Sickle Cell Anemia,” was published online in Authorea.