Dr. Lanzkron is seeking this Mentored Patient-Oriented Award to start to examine the barriers to care for adults with sickle cell disease. This research will examine Hydroxyurea (HU) utilization in adults with sickle cell disease (SCD)as well as try to identify some of the barriers to the use of HU in this patient population. These studies will lead to improved health care delivery to individuals with sickle cell disease. The research, mentorship and didatic instruction that is received through this funding, will contribute to Dr. Lanzkron becoming an independent investigator. There has not been any research done looking at adherence to therapy from a patient perspective in the adult sickle cell population. Preliminary data shows that hospitalization rates and the cost of caring for adults with SCO in Maryland (MD) has increased significantly since FDA approval of HU. Furthermore the experience at Johns Hopkins Hospital (JHH) is that 72% of eligible patients with hemoglobin SS disease are not taking HU. The reasons that patients at JHH do not take HU vary and a further examination of HU utilization beyond that of hospitaized patients is warranted. The hypothesis of this grant application is that HU is underutilized in adults with SCO. We hypothesize that both provider and patient factors lead to the underutilization of HU. Preliminary data suggests that many eligible patients on Medicaid in MD are not using HU and when eligible patients have been prescribed HU they are not getting it refilled regularly. The research planned in this award will continue the examination of Medicaid databases to look at how care is delivered to patients in MD and will evaluate pharmacy refill data to look at adherence to HU. A prospective examination of adherence will go to the core of the issue, by addressing both physician and patient concerns with the use of HU. Patient focus groups will be used to address beliefs pertaining to the use of HU and surveys will be sent to physicians to assess their knowledge of HU and their concerns with prescribing HU. Dr. Lanzkron has established a Sickle Cell Center to provide qualtiy care for patients. Now she is working toward becoming a skilled investigator by obtaining an MSH degree and examining issues related to the barriers to care for her patients. She has selected mentors in behavioral research, epidemiology and sickle cell that provide the necessary supervision to make her a successful independent investigator.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL083089-05
Application #
8215781
Study Section
Special Emphasis Panel (ZHL1-CSR-R (O3))
Program Officer
Werner, Ellen
Project Start
2008-03-01
Project End
2014-01-31
Budget Start
2012-02-01
Budget End
2014-01-31
Support Year
5
Fiscal Year
2012
Total Cost
$140,130
Indirect Cost
$10,380
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Haywood Jr, Carlton; Diener-West, Marie; Strouse, John et al. (2014) Perceived discrimination in health care is associated with a greater burden of pain in sickle cell disease. J Pain Symptom Manage 48:934-43
Haywood Jr, Carlton; Lanzkron, Sophie; Diener-West, Marie et al. (2014) Attitudes toward clinical trials among patients with sickle cell disease. Clin Trials 11:275-283
Haywood Jr, Carlton; Bediako, Shawn; Lanzkron, Sophie et al. (2014) An unequal burden: poor patient-provider communication and sickle cell disease. Patient Educ Couns 96:159-64
Naik, Rakhi P; Streiff, Michael B; Lanzkron, Sophie (2013) Sickle cell disease and venous thromboembolism: what the anticoagulation expert needs to know. J Thromb Thrombolysis 35:352-8
Carroll, Patrick C; Haywood Jr, Carlton; Hoot, Michelle R et al. (2013) A preliminary study of psychiatric, familial, and medical characteristics of high-utilizing sickle cell disease patients. Clin J Pain 29:317-23
Naik, Rakhi P; Streiff, Michael B; Lanzkron, Sophie (2013) The reply. Am J Med 126:e15
Haywood Jr, Carlton; Tanabe, Paula; Naik, Rakhi et al. (2013) The impact of race and disease on sickle cell patient wait times in the emergency department. Am J Emerg Med 31:651-6
Lanzkron, Sophie; Carroll, C Patrick; Haywood Jr, Carlton (2013) Mortality rates and age at death from sickle cell disease: U.S., 1979-2005. Public Health Rep 128:110-6
Naik, Rakhi P; Streiff, Michael B; Haywood Jr, Carlton et al. (2013) Venous thromboembolism in adults with sickle cell disease: a serious and under-recognized complication. Am J Med 126:443-9
Haywood Jr, Carlton; Lanzkron, Sophie; Hughes, Mark T et al. (2011) A video-intervention to improve clinician attitudes toward patients with sickle cell disease: the results of a randomized experiment. J Gen Intern Med 26:518-23

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