학술논문
A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease
Document Type
article
Author
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; Thompson, Alexis
Source
Blood Advances. 7(23)
Subject
Language
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.