Bimonthly Medical Visits Reduce Sickle Cell Admissions

Background: Sickle cell disease (SCD) is a chronic medical disease that in some patients is characterized by frequent vasoocculsive crisis (VOC). A minority of sickle cell patients comprises a majority of hospital VOC admissions, and the transition to adult care is a particularly high risk time period. We sought to identify if increased frequency of outpatient medical care led to a reduction of hospital days following intervention and if there were improvements in daily function, and reduction of premature requests for opiate refills.

Methods: Retrospective review of 11 patients, average age of 25 (range 19-37 years old), 63% were female. Genotype of SCD included 8/11 with SS, 2/11 with SC and 1/11 with SBeta Thal. Sickle cell standard of care medical visits were monthly at our institution. Two nurse practitioners and 2 hematologists at the medical center implemented the intervention of increased frequency of medical visits to bimonthly follow up for between 5 and 48 weeks, with a mean length of 12 weeks of increased frequency of medical visits.

Results: In the 6 months preceding intervention there were a total of 300 hospital days of admission for VOC (2 patients <10 hospital days, 6 patients with 10-20 hospital days, 3 patients with over 20 hospital days; range 27-111 days). During the intervention 7/11 patients had no hospitalizations, 2/11 were discharged from the emergency department and never admitted. Another patient had 7 days of admission over 34 weeks of bimonthly medical visits and 1 patient had increase to days 37 days over 22 weeks of bimonthly medical visits. The average length of follow up after the intervention was 25 weeks: 4/11 had reduction of hospital days, 2/11 had the same number of hospital days and 4/11 had more hospital days. Secondary benefits were 3/11 patients were able to restart and maintain employment, 2/11 were able to re-enroll in educational programs, and 3/11 had a reduction in premature requests for opiate refills.

Conclusions: Increased frequency of outpatient medical visits leads to reduced hospital admission time for some patients and subjective improvement in daily function as measured by the ability to work or go to school. Future research is needed address the small subset of young adults who had an increase in hospital admission.

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