Assessing multilevel barriers to hydroxyurea adherence in youth with sickle cell disease using pharmacy-based refill records.

Autor: Smaldone A; Columbia University School of Nursing, New York, New York, USA.; College of Dental Medicine, Columbia University Medical Center, New York, New York, USA., Manwani D; Department of Pediatrics, Division of Hematology, Oncology and Cellular Therapy, Albert Einstein College of Medicine, New York, New York, USA., Aygun B; Northwell, New Hyde Park, New York, USA.; Pediatric Hematology Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, New York, USA., Appiah-Kubi A; Northwell, New Hyde Park, New York, USA.; Pediatric Hematology Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, New York, USA., Smith-Whitley K; Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Global Blood Therapeutics, South San Francisco, California, USA., Green NS; Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Therapy, Columbia University Medical Center, New York, New York, USA.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2024 Sep; Vol. 71 (9), pp. e31170. Date of Electronic Publication: 2024 Jul 08.
DOI: 10.1002/pbc.31170
Abstrakt: Background: Suboptimal medication adherence is common across youth with chronic health conditions and may contribute to health disparities and adverse health outcomes, especially in underserved communities.
Methods: Using pharmacy prescription records and guided by the World Health Organization Multidimensional Adherence Model, we examined patient-, treatment-, and health system-related factors that may affect hydroxyurea adherence in 72 youth with sickle cell disease (SCD), 10-18 years who had participated in the multisite "Hydroxyurea Adherence for Personal Best in SCD" (HABIT) feasibility (6 months) and efficacy (12 months) trials. Pharmacy data were collected from the year prior to study entry through the duration of each trial. We also examined hydroxyurea dose at baseline, prescribing patterns (hydroxyurea formulation and dose prescribed), quantity of hydroxyurea dispensed, and number of daily capsules/tablets prescribed. Data were analyzed using descriptive statistics.
Results: On average, youth were prescribed 1095 ± 402 mg hydroxyurea per day, requiring ingestion of 3 or more capsules for 39.4% of youth. Frequently identified potential barriers were complex medication regimens in which dose of hydroxyurea differed by day of week (47.2%); receipt of an inadequate (< 30 days) supply of hydroxyurea from the pharmacy ≥ 3 times during record collection period (29.2%); and prescription of hydroxyurea suspension suggesting problems swallowing capsules (22.2%). In this sample, most youth were exclusively prescribed 500 mg capsules (62.5%), which was associated with complex medication regimens (RR 3.0, 95% CI 1.4-6.7). Potential barriers were common, occurred at all levels and are potentially modifiable with targeted interventions at the treatment- and health system-related levels.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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