Evaluating the Impact of Telehealth on Hydroxyurea Response

After conducting a one-year retrospective chart review, investigators found that the use of telehealth did not negatively impact laboratory response to hydroxyurea (HU) in patients with sickle cell anemia (SCA).

A team of investigators led by Sarah Shaner, University of Alabama at Birmingham School of Medicine, conducted a one-year retrospective chart review in order to analyze hydroxyurea laboratory and clinical response based on socioeconomic status and clinic location for patients with sickle cell anemia.

Motivation

The National Institutes of Health (NIH) estimates 22 million residents live in rural areas with a shortage of healthcare providers. The University of Alabama at Birmingham (UAB) Pediatric Sickle Cell program utilizes satellite clinics paired with telehealth to reduce the issue of transportation and offer an alternative to traveling to the university-based clinic.

The US Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion has recognized that rural patients living with chronic diseases are more likely to have poor outcomes. Telehealth is one of the ways they recommend improving outcomes in rural populations.

With the extra convenience, however, comes less immediacy. For patients who received hydroxyurea therapy at a satellite clinic, their labs were obtained on the day of their clinic visit but the complete blood count (CBC) was performed in a local lab and sent back to University of Alabama at Birmingham. Then, the fetal hemoglobin levels are processed by the medical team on campus.

Telehealth

With this procedure, sickle cell providers weren’t able to have access to the hydroxyurea dosing labs during the patient’s satellite clinic visit. This is where telehealth came in.

Investigators were able to develop a telehealth model that streamlined the patient’s lab results to a nurse who would evaluate the values relevant to the institutional hydroxyurea dosing guidelines, confirm dosing changes with a sickle cell provider, and then call the patient to review results and changes and answer any questions.

The investigators questioned if the use of telehealth dosing adjustments had an impact on hydroxyurea laboratory and clinical response compared with university-based patients. Results showed no significant negative impact.

Results

There was no difference identified in fetal hemoglobin, mean corpuscular volume, or absolute neutrophil count when comparing the satellite clinics to the university based-clinic.

Clinic location also had no impact on the overall number of hospital admissions or the number of pain admissions. Although, acute pain visits were higher among patients visiting the university-based clinic.

The socioeconomic indicators for patients who attended the satellite clinics were significantly worse when compared with the university-based clinic. The poverty level was higher, the median household income lower, and the amount of adults in the community without a high school degree was higher.

As the investigators predicted, nonadherence to hydroxyurea was associated with the highest number of hospital admissions. Of 149 patients who had more than 1 visit, 97 patients had more than 65% of clinic visits with a correct dose adjustment.

No statistical difference was identified in correct dosing adjustment between the locations. Overall, establishing satellite clinics and telehealth practices has shown to be just as effective in treating patients with hydroxyurea therapy as at the traditional university-based treatment.

This study, “Impact of telehealth visits on hydroxyurea response in sickle cell anemia”, was published in Pediatric Blood & Cancer.