镰状细胞病的羟基脲疗法：低收入和中等收入环境下医疗服务提供者的知识与处方模式
Hydroxyurea therapy in sickle cell disease: knowledge and prescription patterns among care providers in a low-and middle-income setting.
作者信息
Ofakunrin Akinyemi O D, Okpe Edache Sylvanus, Olaosebikan Rasaq, Ukpoju-Ebonyi Onyeka Mary, Afolaranmi Tolulope Olumide, Kilson Dangkat Bitrus, Oguche Stephen
机构信息
Department of Paediatrics, Faculty of Clinical Sciences, University of Jos &Jos University Teaching Hospital, Jos, Nigeria.
Department of Paediatrics, Federal University of Health Sciences Teaching Hospital, Otukpo, Nigeria.
出版信息
Niger Med J. 2025 Apr 3;66(1):198-209. doi: 10.71480/nmj.v66i1.675. eCollection 2025 Jan-Feb.
BACKGROUND
Hydroxyurea is a safe, effective, and well-tolerated disease-modifying therapy for patients with sickle cell disease (SCD), leading to reduced morbidity, mortality, and an improved quality of life. However, its underutilization, driven by inadequate knowledge and variability in use among SCD care providers, may limit its benefits. This study assessed the knowledge and prescription patterns of hydroxyurea among SCD care providers in Jos, Nigeria.
METHODOLOGY
A cross-sectional survey of 132 physicians managing SCD was conducted to collect data on socio-demographics, hydroxyurea knowledge, and prescription patterns using a proforma. Knowledge was assessed using 17 questions (maximum score: 17). Scores above 12 (50th percentile) were classified as "good," while scores of 12 or below were categorized as "poor." Prescription patterns were evaluated against the National Institutes of Health (2014) and British Society for Haematology (2018) guidelines. Data were analyzed using descriptive and inferential statistics.
RESULTS
Sixty-seven (50.8%) of the 132 physicians had inadequate knowledge of hydroxyurea's clinical benefits and safety. Only 35 (26.5%) were aware of available treatment guidelines, and 32 (24.2%) had ever prescribed hydroxyurea. Among prescribers, nine (28.1%) used inappropriate criteria to initiate treatment and six (18.8%) prescribed below recommended doses. The median maximum daily prescribed dose was 750mg, whereas five (15.6%) physicians did not exceed 200mg, irrespective of patient weight. Treatment guidelines were not followed by 25 (78.1%) of prescribers.
CONCLUSION
This study revealed a high prevalence of inadequate knowledge and inconsistent hydroxyurea prescription practices among SCD care providers. Targeted training is essential to enhance hydroxyurea utilization and ensure adherence to standardized treatment guidelines, ultimately improving patient outcomes.
背景
羟基脲是一种用于镰状细胞病（SCD）患者的安全、有效且耐受性良好的病情改善疗法，可降低发病率、死亡率并改善生活质量。然而，由于SCD护理提供者知识不足以及使用存在差异，导致其未得到充分利用，这可能会限制其益处。本研究评估了尼日利亚乔斯市SCD护理提供者对羟基脲的知识和处方模式。
方法
对132名管理SCD的医生进行了横断面调查，使用一份表格收集有关社会人口统计学、羟基脲知识和处方模式的数据。通过17个问题（最高分：17分）评估知识水平。得分高于12分（第50百分位数）被归类为“良好”，而得分12分及以下被归类为“差”。根据美国国立卫生研究院（2014年）和英国血液学学会（2018年）的指南评估处方模式。使用描述性和推断性统计分析数据。
结果
132名医生中有67名（50.8%）对羟基脲的临床益处和安全性知识不足。只有35名（26.5%）知晓现有治疗指南，32名（24.2%）曾开过羟基脲处方。在开处方者中，9名（28.1%）使用不适当的标准开始治疗，6名（18.8%）的处方剂量低于推荐剂量。规定的最大每日剂量中位数为750毫克，而5名（15.6%）医生无论患者体重如何，剂量都不超过200毫克。25名（78.1%）开处方者未遵循治疗指南。
结论
本研究表明，SCD护理提供者中知识不足和羟基脲处方做法不一致的情况很普遍。有针对性的培训对于提高羟基脲的利用率和确保遵循标准化治疗指南至关重要，最终可改善患者预后。
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