Enhancing Use of Hydroxyurea In Sickle Cell Disease Using Patient Navigators (SHiP HU)
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|ClinicalTrials.gov Identifier: NCT02197845|
Recruitment Status : Completed
First Posted : July 23, 2014
Last Update Posted : June 26, 2019
Multi-phase, patient navigator-based program in the Richmond and Tidewater regions of Virginia to demonstrate:
- the feasibility of using patient navigators to improve the percentage of children and adult (age 15 and older) patients with sickle cell disease (SCD) in SCD specialty care
- the efficacy of using patient navigators to improve hydroxyurea (HU) (re-)initiation and adherence among adult patients with SCD eligible for HU
(Patient navigators may also be known as public health workers.)
|Condition or disease||Intervention/treatment||Phase|
|Sickle Cell Disease||Behavioral: Patient Navigator Behavioral: Recruitment into Specialty Care||Not Applicable|
The state of Virginia, including the Virginia Department of Health and three academic medical centers and one federally qualified health center, plans a two-phase demonstration, first of improvement in the percentage of adults with SCD who are in SCD specialty care (Phase I), then of improvement in adherence to HU of eligible SCD adults (Phase II). Both phases will use existing academic SCD providers, and an innovative, multimodal strategy, featuring specially trained SCD patient navigators (PNs), that addresses barriers to care and to HU use. In Phase I we will demonstrate the feasibility of utilizing PNs to overcome patient access barriers to SCD care. In Phase II we will test the efficacy of PNs for overcoming barriers to acceptance of and adherence with HU therapy. Patients will be randomized to a PN arm or to a usual care arm. Providers will implement NIH guidelines for HU eligibility and prescribing in both arms. All HU eligible patients will be offered HU at each clinical visit. Among patients prescribed HU, if a maximum tolerated dose (MTD, defined in end points) has not been reached, providers will dose escalate every 8-12 weeks to MTD, rather than to clinical effect, before declaring treatment success or failure.
This project will be critically important and impactful by demonstrating the feasibility of a statewide community-based strategy to assist vulnerable SCD adults in obtaining SCD specialty care and likely prolonging life, a model that other states could adopt.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||353 participants|
|Intervention Model:||Parallel Assignment|
|Primary Purpose:||Health Services Research|
|Official Title:||Enhancing Use of Hydroxyurea In Sickle Cell Disease Using Patient Navigators|
|Actual Study Start Date :||October 2012|
|Actual Primary Completion Date :||July 7, 2018|
|Actual Study Completion Date :||December 31, 2018|
Experimental: Phase I: Recruitment into Specialty Care
Participants in the Phase I Experimental Arm are enrolled into SCD specialty care. PN's will contact patient up to 3 times to assure patients have had an initial visit by 3 months time.
Behavioral: Recruitment into Specialty Care
A specially trained (SCD knowledgeable) Patient Navigator will act as a liaison to participants in increasing adherence to Hydroxyurea. Interventions utilized by a PN include teaching disease management skills, addressing barriers to care, disease education, HU management, motivational interviewing, care coordination and social support.
Other Name: Sickle Cell Disease Specialty Care
Experimental: Phase II: Patient Navigator Arm
Participants in the Phase II Experimental Arm follow routine clinical care and are assigned a Patient Navigator. A specially trained (SCD specefic)PN will work with participants for one year. Participants will be contacted by their Navigator weekly for the first 6 months, then biweekly for the second 6 months.
Behavioral: Patient Navigator
A specially trained (SCD knowledgable) Patient Navigator will act as a liaison who assists participants in increasing adherence to HU through disease education, addressing barriers to care and improving adherence to HU. PN utilize various techniques geared toward the individual patients needs. Interventions utilized by a PN include improving disease management skills, educational materials about disease, HU adherence, motivational interviewing, care coordination and social support.
No Intervention: Phase II: Passenger Arm
No Intervention. Participants in the Phase II Passenger Arm follow routine clinical care.
- Phase I: Percent of enrolled Phase I subjects who complete a provider visit by 3 months post enrollment [ Time Frame: 3 months ]
- Phase II: Increase in fetal hemoglobin (HbF) as measured by hemoglobin electrophoresis [ Time Frame: Baseline, 6 months, 1 year ]
- Phase II: Measures of adherence to HU [ Time Frame: Baseline, 6 months, 1 year ]For patients prescribed HU, clinical research coordinators will assess HU prescription refills from pill counts, pharmacy records, and self-report at baseline, 6 months, and 1 year. Patient navigators will regularly assess their patients' HU adherence by conducting pill counts at home visits.
- Phase II: Percent of patients achieving either maximum tolerated dose (MTD) or maximum dose [ Time Frame: Baseline, 6 months, 1 year ]Maximum tolerated dose (MTD) is the daily single oral dose that can be maintained for at least 16 weeks without toxicity (< 3 x l09 neutrophils/L, <100 x l09 platelets/L, < 125 x l09 reticulocytes/L, 20% drop in [Hb] or an absolute value of <4.5 g/dL, 50% rise in creatinine or absolute increase of >0.4 mg/dL, 100% rise in ALT,GI disturbance, or rash or hair loss not attributable to other causes). Maximum dose is 35 mg/kg.
- Phase II: Number of emergency department and hospital visits [ Time Frame: Baseline, 6 months, 1 year ]
- Phase II: Mean corpuscular volume [ Time Frame: Baseline, 6 months, 1 year ]
- Phase II: Total hemoglobin [ Time Frame: Baseline, 6 months, 1 year ]
- Phase II: White blood cell count [ Time Frame: Baseline, 6 months, 1 year ]
- Phase II: Reticulocyte count [ Time Frame: Baseline, 6 months, 1 year ]
- Phase II: Quality of life measures [ Time Frame: Baseline, 6 months, 1 year ]Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me), Patient Reported Outcomes Measurement Information System (PROMIS)
- Phase II: Patient activation measures [ Time Frame: Baseline, 6 months, 1 year ]Patient Activation Measure
- Phase II: Patient knowledge measures [ Time Frame: 1 year ]Assessment of Sickle Cell Knowledge - University of Florida (UF-ASCK) (unpublished)
- Phase II: Health care knowledge and skills, self-efficacy, sickle cell stress measures [ Time Frame: Baseline, 6 months, 1 year ]Sickle Cell Transition intervention Program (TIP) Survey (non-validated)
- Phase II: Social support measures [ Time Frame: Baseline, 6 months, 1 year ]Sickle Cell Transition intervention Program (TIP) Survey (non-validated) and Multidimensional Scale of Perceived Social Support
- Phase II: Coping strategies [ Time Frame: Baseline, 6 months, 1 year ]Coping Strategies Questionnaire for SCD
- Phase II: Associated pain conditions and comorbidities [ Time Frame: Baseline, 6 months, 1 year ]Chart Review, Self Report and Surveys: Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me), Patient Reported Outcomes Measurement Information System (PROMIS)
- Phase II: Blood transfusion measures (if applicable) [ Time Frame: 6 months, 1 year ]Chart review
- Phase II: Patient Navigator Satisfaction (if applicable) [ Time Frame: 1 year ]Patient Navigator Satisfaction Surveys, 12 month follow up, Patient Study Experience Review for Patient Navigators
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02197845
|United States, Virginia|
|Virginia Commonwealth University|
|Richmond, Virginia, United States, 23298|
|Principal Investigator:||Wally R Smith, MD||Virginia Commonwealth University|