A quantitative analysis examining the factors influencing the caregivers decision to hydroxyurea acceptance or nonacceptance in pediatric sickle cell patients\ud

Background: There are about 95,000 Americans living with sickle cell disease. The illness can lead to a host of complications including painful vaso-occlusive episodes, acute chest syndrome, stroke, splenic and hepatic sequestrations, avascular necrosis, infection and pulmonary hypertension. Hydroxyurea therapy has been shown to be effective in reducing the number of complications in sickle cell disease, however this treatment is often underutilized. \ud Objective: It is imperative that individuals with severe sickle cell disease are educated about the benefits and risks of the therapy in order to increase acceptance and adherence to the drug. This study seeks to identify the factors and quantitative characteristics that influence the pediatric patients’ caregiver’s decision to hydroxyurea acceptance and nonacceptance.\ud Methods: Eighteen pediatric patient medical records were analyzed in order to obtain information as to the quantitative factors that influence pediatric sickle cell patients’ caregiver’s decision to hydroxyurea acceptance and nonacceptance. \ud Results: Both those who accepted hydroxyurea and those who did not accept hydroxyurea had overall high hemoglobin levels, low reticulocyte counts and normal platelet counts for individuals with sickle cell disease. The group of patients who did not accept hydroxyurea tended to have white blood cell counts above the normal range whereas patients who accepted hydroxyurea therapy tended to have normal white blood counts. \ud Conclusions: After completion of the study and review of current literature it is made clear that new interventions are needed in order to increase knowledge about the benefits of hydroxyurea. An ideal intervention would be a targeted educational approach focused in the Health Belief Model that utilizes visual aids to explain the increase in healthy red blood cells that accompanies adherence to hydroxyurea. \ud Public Health Significance: Sickle cell disease is a major public health concern because the frequent hospitalizations associated with the disease are costly. Annual medical costs for children with sickle cell disease averaged $15,000 in 2005 and from 1989-1993 there was an average of 75,000 hospitalizations for individuals with sickle cell disease costing nearly $475 million. Complications of sickle cell disease along with the high economic burden can be minimized with the use of hydroxyurea therapy. \ud \u