Impact of an individualized pain plan to treat sickle cell disease vaso-occlusive episodes in the emergency department
Year: 2024
Type: article
Study design: Clinical Trial
Abstract: ABSTRACT: To address acute vaso-occlusive episodes (VOEs), the leading cause of emergency department (ED) visits among individuals with sickle cell disease (SCD), we conducted the clinical study, ALIGN (An Individualized Pain Plan with Patient and Provider Access for Emergency Department care of SCD), across 8 sites. We hypothesized an improvement of 0.5 standard deviations in perceived quality of ED pain treatment of a VOE after implementing individualized pain plans (IPPs) accessible to both patients and providers. Patients with SCD were aged 18 to 45 years, owned a cell phone, and had an ED VOE visit within 90 days prior. Patients completed the perceived quality of care surveys at baseline and within 96 hours after an ED VOE visit. Providers completed surveys regarding comfort managing VOEs at baseline and after managing an enrolled patient. Most of the 153 patients were African American (95.4%), female (64.7%), and had Hb SS/Sβ0 genotype (71.9%). The perceived quality of ED pain treatment was high at both baseline and after implementation of IPPs; our primary outcome hypothesis was not met, because no statistically significant change in the patient-perceived quality of ED treatment occurred. A total of 135 providers completed baseline and follow-up surveys. On a scale of 1 to 7, with 7 being extremely comfortable managing VOEs, 60.5% reported a score ≥6 after IPP implementation vs 57.8% at baseline. Almost all (97.6%) ordered the recommended medication, and 94.7% intended to use IPPs. In this implementation protocol, all sites successfully implemented IPPs. Patients and ED providers both endorsed the use of IPPs. This trial was registered at www.ClinicalTrials.gov as # NCT04584528.
Source: Blood Advances
Institutions: Duke University, Washington University in St. Louis, Medical University of South Carolina, Mayo Clinic, St. Jude Children's Research Hospital, University of Illinois Chicago, RTI International, New York University, University of California, San Francisco, Icahn School of Medicine at Mount Sinai, Augusta University
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
Awards: G1320814302, G2095060056, SC-Links - Linking the Sickle Cell Community, Providers and Systems to Improve Sickle Cell Disease Care, G2724382595, G2908589470, Improving Sickle cell care in Adolescents & Adults in Chicago (ISAAC), The Implementation of Cognitive Screening and Educational Support to Improve Outcomes of Adolescents and Young Adults with Sickle Cell Disease: From Clinic to the Community and Back, G3789537736, G3813675775, Data Coordinating Center for Sickle Cell Disease Implementation Consortium (SCDIC), RE-aiming at Hydroxyurea Adherence for Sickle cell with mHealth (RE-HASH), G4772206542, Implementation of a Sickle Cell Enhanced Novel Care Network in South Carolina (iSCENSC), Improving SCD Care using Web-based Guidelines, Nurse Care Managers and Peer Mentors in Primary Care and Emergency Departments in Central North Carolina, G5016758722, G5265491106, G5531805118, G5645816113, G5977062928, New York City Sickle Cell Implementation Science Consortium, Implementation of Medical Homes for Evidence Based Care of Adolescents and Adults with Sickle Cell Disease, G6362927184, G6582556994, G6691326575, G687132063, G7333336489, G7823699828, G7888730243
OpenAlex ID: W4399167139