Mbaezue Rheiner N, Okafor Adetoro T, Nkwocha Bernard I, Ibeneme Chidalu N, Opara Amoge C, Akahara Darlington E, Okobi Okelue E
Health Services, Department of Health, Cape Town, ZAF.
Public Health, University of Limpopo, Polokwane, ZAF.
Cureus. 2023 Sep 6;15(9):e44780. doi: 10.7759/cureus.44780. eCollection 2023 Sep.
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.
镰状细胞病（SCD）是一种男女均易患的慢性疾病，由于其相关的发病率和并发症，在美国仍然是一个公共卫生负担。尽管医学知识有所进步，并且针对该疾病的新型治疗方法也在不断设计，但由于许多国家全球流离失所和经济动荡导致移民率上升，其负担仍然加重。因此，我们对2000年至2022年的出版物进行了全面的文献综述，以收集有关管理SCD的指南，通过四个数据库进行搜索，即PubMed、Embase、谷歌学术和Cochrane；经过全文筛选过程，42篇文章符合最终纳入标准。在美国医疗保健系统中，初级保健医生（PCP）通常是负责慢性疾病终身管理的提供者，SCD也不例外。虽然现在有更多的SCD患者前往初级保健诊所就诊，但许多PCP仍然缺乏有效管理该疾病所需的信心和足够经验。能够提供全面SCD护理的PCP短缺所造成的差距导致患者健康结果不佳。现在比以往任何时候都更有必要在提供者层面继续提高对这种疾病的认识，以确保患者获得全面的护理，从而改善他们的生活质量和临床结果。提供有关SCD现有和新型治疗方法及/或方式的最新知识无疑会使PCP有信心熟练地管理该疾病。因此，我们探讨了各种公共卫生干预措施，如羟基脲疗法、肺炎球菌疫苗接种、青霉素疗法、铁螯合疗法以及在初级医疗保健环境中实施并已证明对改善SCD护理有效的临床决策支持工具。我们还讨论了最近的进展，这些进展可能会在未来改善SCD患者的治疗结果。
