Abstract

Authors:
Ms. Kamira Brown- Texas A&M University School of Public Health/Sickle Cell Association of Houston

Objective: SCD is a rare, inherited blood disorder that affects approximately 100,000 Americans, majority of them being African American. Patients usually utilize the ED for treatment of pain caused by VOCs. Unfortunately, there have been numerous cases of SCD patients expressing frustration towards the type of care they receive from healthcare providers. This systematic review sets out to determine unfair treatment SCD patients may be enduring in the ED, along with underrepresented funding given towards SCD research.
Methods: Using the search engine PubMed, articles were selected that were published between the years 2010 and 2017. The search was undertaken using keywords such as “sickle cell patient,” “healthcare personnel,” “treatment,” “attitudes,” and “inequality.”
Results: Thirteen articles with findings from the United States met the inclusion criteria. Focusing on emergency provider’s attitudes towards SCD patients, a bivariate analysis was completed, examining the mean scores of the healthcare participants attitudes before and after the showing of an intervention video. The mean score of negative attitudes decreased from 40.8 pre-intervention to 29.3 post-intervention. Whereas, the mean score for positive attitudes increased pre to post-intervention from 34.8 to 44.8. It was found without adjustments for patient or hospital characteristics such as age, insurance status, or ambulatory arrival; SCD patient wait times were 25% longer on average to see a physician in the ED in comparison to the General Patient Sample and 59% longer compared to the LBF patients. Funding per affected individual with cystic fibrosis was 7.6 times greater in 2010 and 11.4 times greater in 2011 in comparison to funding per individual affected by SCD. Funding provided by the National Institute of Health (NIH) was 3.5 times higher for cystic fibrosis compared to SCD. As for national foundation funding, funding for cystic fibrosis was 370 times higher in 2010 and 440 times higher in 2011 than funding for SCD foundations.
Conclusions: It has been estimated that 20% of doctors don’t feel comfortable treating SCD patients because of lack of training. The showing of an informational video better informing provider’s on SCD can in turn increase attitudes towards providing care for SCD patients. The lengthy delays SCDs patients are experiencing are on average 70-75 minutes longer than the American Physical Society (APS) guideline recommends, showing that ED have major room for improvement in treating SCD patients. There is a great difference in NIH and national foundation funding being dispersed per individual with cystic fibrosis compared to SCD individuals. SCD is receiving nowhere near the financial resources required for research depending on the amount of people affected by the disease. Improvements need to be made to increase the focus towards SCD to increase research, clinical trials, publications, and treatment drugs.