1. A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease
- Author
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Hankins, Jane S, Brambilla, Donald, Potter, Michael B, Kutlar, Abdullah, Gibson, Robert, King, Allison A, Baumann, Ana A, Melvin, Cathy, Gordeuk, Victor R, Hsu, Lewis L, Nwosu, Chinonyelum, Porter, Jerlym S, Alberts, Nicole M, Badawy, Sherif M, Simon, Jena, Glassberg, Jeffrey A, Lottenberg, Richard, DiMartino, Lisa, Jacobs, Sara, Fernandez, Maria E, Bosworth, Hayden B, Klesges, Lisa M, Shah, Nirmish, Hodges, Jason, Carroll, Yvonne, Klesges, Lisa, Khan, Hamda, Smeltzer, Matthew, Gurney, James, Porter, Jerlym, Alberts, Nicole, French, Reginald, Badawy, Sherif, DeBaun, Michael, Kang, Guolian, Estepp, Jeremie, Wang, Winfred, Owens, Curtis, Debon, Margaret, Osarogiagbon, Ray, Nelson, Marquita, Treadwell, Marsha, Vichinsky, Elliott, Wun, Ted, Potter, Michael, Hessler, Danielle, Hagar, Ward, Marsh, Anne, Neumayr, Lynne, Kanter, Julie, Phillips, Shannon, Adams, Robert, Mueller, Martina, Abrams, Tina, Davia, Nathalia, Tanabe, Paula, Bosworth, Hayden, Jackson, George, Johnson, Fred, Richesson, Rachel, Prvu-Bettger, Janet, King, Allison, Baumann, Ana, Calhoun, Cecilia, Snyder, Angie, Fernandez, Maria, Richardson, Lynne D, Glassberg, Jeffrey, Genes, Nicholas G, Loo, George T, Shapiro, Jason S, Souffront, Kimberly, Clesca, Cindy, Linton, Elizabeth, Ryan, Gery, Kroner, Barbara L, Hendershot, Tabitha, Battestilli, Whitney, Cox, Lisa, Preiss, Liliana, Pugh, Norma, Li, Sophie, VonLehmden, Annie, Smith, Sharon M, Tonkins, William P, Peters-Lawrence, Marlene, Boyce, Cheryl, Barfield, Whitney, and Thompson, Alexis
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Health Services ,Clinical Trials and Supportive Activities ,Chronic Pain ,Pain Research ,Hematology ,Sickle Cell Disease ,Clinical Research ,Rare Diseases ,Management of diseases and conditions ,7.1 Individual care needs ,Good Health and Well Being ,Adult ,Female ,Humans ,Male ,Anemia ,Sickle Cell ,Hydroxyurea ,Medication Adherence ,Pain ,Telemedicine ,Cardiovascular medicine and haematology - Abstract
Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167.
- Published
- 2023