The Effectiveness of Common Interventions in the Management of Sickle Cell Disease in Primary Care Settings: A Review

Rheiner N Mbaezue; Adetoro T Okafor; Bernard I Nkwocha; Chidalu N Ibeneme; Amoge C Opara; Darlington E Akahara; Okelue E Okobi

doi:10.7759/cureus.44780

The Effectiveness of Common Interventions in the Management of Sickle Cell Disease in Primary Care Settings: A Review

Cureus. 2023 Sep 6;15(9):e44780. doi: 10.7759/cureus.44780. eCollection 2023 Sep.

Authors

Rheiner N Mbaezue^{1

2}, Adetoro T Okafor³, Bernard I Nkwocha⁴, Chidalu N Ibeneme⁵, Amoge C Opara⁶, Darlington E Akahara⁷, Okelue E Okobi^{8

9

10}

Affiliations

¹ Health Services, Department of Health, Cape Town, ZAF.
² Public Health, University of Limpopo, Polokwane, ZAF.
³ Epidemiology and Public Health, University of Minnesota School of Public Health, Minneapolis, USA.
⁴ Internal Medicine, University of Utah College of Medicine, Salt Lake City, USA.
⁵ Public Health, University of Toledo, Toledo, USA.
⁶ Medicine and Surgery, Biologic Delivery Technologies, Reno, USA.
⁷ Medicine, Windsor University School of Medicine, Cayon, KNA.
⁸ Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA.
⁹ Family Medicine, Medficient Health Systems, Laurel, USA.
¹⁰ Family Medicine, Lakeside Medical Center, Belle Glade, USA.

Abstract

Sickle cell disease (SCD), a chronic condition that affects men and women equally, continues to present a public health burden in the United States due to its associated morbidity and complications. Despite advances in medical knowledge and the design of novel therapies for managing the disease, its burden remains compounded because of increasing rates of immigration arising from global displacements and economic unrest in many countries. We thus conducted a comprehensive literature review of publications from 2000 to 2022 to gather guidelines on managing SCD, with a search through four databases, PubMed, Embase, Google Scholar, and Cochrane; 42 articles met the final inclusion criteria after the full-text article screening process. In the United States healthcare system, primary care physicians (PCPs) are generally providers who cater to the lifelong management of chronic medical conditions, SCD not being an exception. While more SCD patients now present to primary care clinics, many PCPs still lack the confidence and adequate experience necessary to manage the condition effectively. The gap created by the shortage of PCPs extensively equipped to provide comprehensive SCD care leads to poor health outcomes for patients. It is imperative now more than ever to continue to raise awareness about this condition at the provider level, to ensure that patients receive well-rounded care to improve their quality of life and clinical outcomes. Providing up-to-date knowledge about existing and novel therapies and/or modalities of SCD treatment would undoubtedly equip the PCPs with self-assurance to manage the condition adeptly. Thus, we explore various public health interventions such as hydroxyurea therapy, pneumococcal vaccination, penicillin therapy, iron chelation therapy, and clinical decision support tools that have been implemented in primary healthcare settings and shown to be effective in improving SCD care. We also discuss recent advancements that can lead to improved outcomes for SCD patients in the future.

Keywords: anemia; interventions; primary care; sickle cell disease; sickle cell trait; strategies.

Publication types

Review