source: American Society of Hematology

year: 2017

authors: Foluso Joy Ogunsile, Zhuo Tony Su, Sophie Lanzkron, Jodi Segal

Sickle cell disease (SCD) affects approximately 100,000 people in the United States (US) and accounts for 75,000 hospitalizations and $475 million in hospitalization costs per year. There is little information about which physician specialists provide the majority of outpatient care and their prescribing practices for SCD. Many suspect much of adult SCD outpatient care is provided by emergency medicine physicians because of lack of access to high quality care from hematologists and primary care. Here, we evaluate a facet of care in SCD by evaluating the outpatient medications frequently prescribed to SCD patients and the physician specialties most involved in writing those prescriptions.

Methods: We used the National Disease and Therapeutic Index (NDTI), a nationally representative audit of outpatient visits in the continental US conducted by IMS Health. The survey includes approximately 4100 sampled physicians each calendar quarter who provide information about every clinical encounter during 2 consecutive workdays. Physicians are selected by random-stratified sampling by specialty and geographic region from the master lists of the American Medical Association and the American Osteopathic Association. The complex sampling frame allows extrapolation to national estimates for outpatient visits and associated prescriptions. Data for each visit include patient diagnoses based on codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and medications prescribed during these visits. The complex sampling frame allows extrapolation to national estimates for office visits and associated prescriptions. We analyzed medications prescribed for the years 2012 through 2015 for patients with SCD. Our analyses included all visits by patients with a recorded SCD diagnosis (International Classification of Diseases, Ninth Revision [ICD-9] codes 282.41–282.42, 282.60–282.64, 282.68, or 282.69). We used descriptive statistics to examine the counts of prescriptions. We aggregated quarterly data from 2012 to 2015 to present annual trends. With linear regression analysis, we assessed the rate of change of prescriptions each year.

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