Comprehensive SCD care may reduce emergency visits for adults
It could boost health outcomes more than centers without primary care: Study
A program that provides integrated primary and specialist care for adults with sickle cell disease (SCD) significantly reduced emergency department visits, according to a study from Massachusetts General Hospital.
“Our Comprehensive Sickle Cell Disease Center (CSCDC) is one of few comprehensive adult care models that integrates [primary care physicians] with outpatient visits and helps establish patients with primary care,” researchers wrote. They hypothesized that this model would improve health outcomes more than a center that does not include primary care.
The study, “Impact of Integrated Primary Care on Care Utilization and Preventative Care for Patients with Sickle Cell Disease,” was published in the Journal of General Internal Medicine.
Study compares integrated center to hematology clinic
SCD is an inherited disorder in which genetic mutations cause defects in hemoglobin, the protein that enables red blood cells to carry oxygen through the body. The faulty protein changes the shape of red blood cells, impeding circulation and leading to a variety of symptoms and complications, including anemia and painful crises caused by oxygen deprivation that can prompt visits to emergency care.
Several approved therapies can ease SCD symptoms, and these are typically prescribed by blood disorder specialists (hematologists). People with SCD also need regular checkups and preventive health screenings to help manage their disease and avoid complications.
In addition to routine hematology visits and access to a blood infusion center, the CSCDC holds multidisciplinary clinics twice a month where patients can receive same-day primary care.
In this study, researchers compared the outcomes of patients seen in the CSCDC with those who were being followed at a similar academic hematology clinic that does not have integrated primary care.
More than 100 adults with SCD who visited each of the clinics were included in the study. Patients were eligible to be included in the analyses if they visited their respective clinic more than once from July 2021 to March 2023. The researchers compared care in the year before and the year after each participant’s final visit during that period.
Patients who went to the hematology clinic were significantly older than those seen in the CSCDC (mean of 38.8 years vs. 33.1 years). Over three-quarters of patients seen at both clinics identified as Black (non-Hispanic).
Patients seen at the hematology clinic went to the emergency department 9.6% more in the year after their last visit compared with the previous year. Patients in the CSCDC, however, showed a 7.2% reduction in the number of emergency department visits, a significant difference.
The CDSDC and hematology clinic differed in terms of integrating primary care physicians and providing continuity for patients. Such steps may lead to decreased emergency department visits, the researchers wrote.
Emergency visits decreased more for some patients
Emergency department visits decreased more in patients who visited the CSCDC for more than one year than in those who went to the clinic for less than a year. This suggests that over time, the benefits of the CSCDC model may have a larger impact, according to the team.
There were slightly greater increases in mental health screenings and preventive screenings for breast and cervical cancer among patients seen in the CSCDC compared with those seen at the hematology clinic. However, none of these differences were considered to be statistically significant.
The researchers noted both clinics included in the study were operated by the same health system, potentially limiting the generalizability of the results.
“More research is needed to study the long-term effects of [the CSCDC] care model in different geographic and practice settings, including impact on overall inpatient utilization, symptom severity, quality of life, and mortality,” they wrote.
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