Patients with sickle cell disease (SCD) who received care in a SCD-pulmonary multidisciplinary clinic demonstrated improved health and reduced need for acute pulmonary care, according to the results of study published in the journal Blood Advances.
Patients with SCD are at risk of pulmonary conditions, which can complicate their SCD care. However, barriers to access pulmonary care are common. The Nationwide Children’s Hospital implemented a multidisciplinary SCD-pulmonary clinic. The aim of this study was to evaluate whether this multidisciplinary care improved outcomes.
The median age of the cohort was 10.2 years, 50% of patients were male, and 50% were exposed to cigarette smoke. The majority of patients had public insurance.
The retrospective chart review evaluated data from 119 patients with SCD who were evaluated in the SCD-pulmonary clinic between 2014 and 2020. The clinic included a team of 2 pediatric hematologists, 2 pediatric pulmonologists, a respiratory therapist, 3 SCD nurse practitioners, 2 SCD nurses, a social worker, a psychologist, a genetic counselor, and a school liaison. Patients were followed for at least 2 years before and after their visit to the clinic.
During the 2 years after receiving care at the multidisciplinary clinic, the median number of acute care visits for acute chest syndrome (ACS; P <.001) and asthma (P =.006) were significantly lower than the 2 years prior.
Patients were more frequently diagnosed with asthma after attending the multidisciplinary clinic at 75% compared with 64% prior to the clinic (P =.0123). Allergic rhinitis was also more frequently diagnosed, at 36% of patients after attending the clinic compared with 23% prior to the clinic (P =.0124).
Prescriptions for the treatment of pulmonary conditions was more common after attending the clinic, including for hydroxyurea (65% vs 52%; P =.005) and inhaled corticosteroids (57% vs 42%; P =.005). In contrast, prescriptions for systemic corticosteroids decreased (P <.0001).
The authors concluded that “implementing a multidisciplinary SCD-pulmonary clinic is feasible and may allow improved management of pulmonary problems and lead ot improvement sin health and acute care utilization.”
Zeno R, Stanek J, Pugh C, et al. Outcomes before and after providing interdisciplinary hematology and pulmonary care for children with sickle cell disease. Blood Adv. Published online December 28, 2022. doi: 10.1182/bloodadvances.2022009079