Kudos to Paula Tanabe, associate dean for research, and Nancy Crego, assistant professor, for submitting their AHRQ COVID-19 supplement application entitled: “Patterns of health care utilization and health care provider perspectives of telehealth for sickle cell disease management before and during the COVID-19 outbreak in North Carolina." This proposal requests funding for a one-year period with a start date of September 1, 2020.

Sickle cell disease (SCD) is a genetic and chronic blood disorder associated with a wide variety of medical complications that result in a shortened lifespan; patients often die in their 40’s. Complications include but are not limited to pulmonary, renal failure, stroke and acute and chronic pain. Hydroxurea (HU) is a drug taken to prevent acute pain and many patients also require chronic opioid therapy. Due to the serious complications and severe pain, many patients have a large number of in-patient stays, emergency department (ED), and ambulatory visits. Individuals with SCD are high risk and healthcare providers and patients have reported avoiding ED and ambulatory visits, as well as avoiding the hospital. Healthcare providers have begun to use telephone and telehealth visits to provide ambulatory care. The purpose of this project is to understand how COVID-19 has changed healthcare use including ED visits, in-patient stays, ambulatory visits, and the use of telephone and telehealth visits, as well as prescribing patterns for HU and opioids. We also will investigate the experience of HCP’s in using this technology.

The specific aims of the project are: 

• Aim 1: Determine whether monthly SCD healthcare utilization and HU prescriptions decreased, and whether opioid prescription refills and telehealth/telephone visits increased in NC Medicaid enrollees in response to COVID-19 county stay at home orders. We will examine NC Medicaid claims, for patterns of monthly healthcare utilization (in-patient stays, ED reliance, ED, ambulatory visits), opioid and HU prescription refills by initiation of COVID-19 stay at home orders by county in enrollees diagnosed with SCD. We will examine data from October 1, 2019, to September 30, 2020, all together, and stratified by age, gender, and urban/rural designation.

• Aim 2: Determine whether monthly SCD healthcare utilization and HU prescription costs decreased, and whether telehealth/telephone visits and opioid prescription refill costs increased in NC Medicaid enrollees in response to COVID-19 county stay at home orders. We will examine NC Medicaid claims for patterns of monthly healthcare utilization, opioid and HU prescription costs by initiation of COVID-19 stay at home orders by county in enrollees diagnosed with SCD. We will examine data from October 1, 2019, to September 30, 2020 all together and stratified by age, gender, and urban/rural designation.

• Aim 3: Explore SCD clinician acceptability, feasibility and adaptation of SCD care management practices with the use of telephone/telehealth for ambulatory visits during the COVID-19 outbreak in NC. We will recruit 14 SCD healthcare providers (PCPs and hematologists) throughout NC that used telephone/telehealth visits to manage the care of SCD patients and conduct semi-structured interviews.