New Measure of Adherence to Antibiotic Use in Kids with Sickle Cell Disease Developed by Researchers

Researchers conducted a study with the aim of developing and validating a Sickle Cell Antibiotic Adherence Level Evaluation (SCAALE) for the accurate assessment of adherence to antibiotic use, a crucial treatment in the management of children with sickle cell disease. The SCAALE proved to be a detailed measurement of adherence and a promoter of clinical care.

The research paper, “A validated measure of adherence to antibiotic prophylaxis in children with sickle cell disease,” was published in Patient Preference and Adherence.

The spleen function of children with sickle cell disease (SCD) is often compromised, increasing the risk of severe infections, progression to sepsis, septic shock, and death. Prevention treatment (prophylaxis) with penicillin has become a staple in the management of children with SCD, but adherence to twice-a-week treatment has been a consistent problem.

Measurement and improvement of adherence may lead to the understanding of such trends and the improvement of treatment outcomes. Numerous methods have been used to measure prophylaxis adherence in SCD, but the information the methods provide has been limited, or their validity and reliability have not been thoroughly proven.

In light of this gap in the understanding of adherence to penicillin prevention therapy, the researchers developed and validated the Sickle Cell Antibiotic Adherence Level Evaluation (SCAALE), a 28-item questionnaire covering seven adherence areas. Three adherence measures were used to demonstrate the SCAALE validity, namely general adherence rating (GAR) by parent, GAR by a healthcare provider, and medication possession ratio (MPR).

GAR determines the patient’s adherence level, in a scale of 1 (rarely or never follows the doctor’s instructions for antibiotic use) to 10 (always follows the doctor’s instructions for antibiotic use). In comparison, MPR is a widely used adherence measure with the advantage of not relying on self-report, instead representing information obtained from known sources.

The results indicated that the evaluation tool was very good to excellent for the total SCAALE and four of the seven subscales. Correlations between SCAALE scores and validation measures were strong for the total SCAALE and five of the seven subscales.

“Evidence from this study supports the reliability and validity of the overall 28-question scale and of most subscales. Development of this scale represents an important contribution to pediatric SCD with clear applicability to clinical management, research programs, and state-funded NBS initiatives,” the researchers wrote.