New mobile health app may help manage hydroxyurea treatments in sickle cell patients

The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), has awarded a 6-year, $4.4 million grant to St. Jude Children's Research Hospital and collaborators to improve the use of prescribed medication by sickle cell patients.

The new Sickle Cell Disease Implementation Program, which comprises a team from St. Jude, the University of Memphis, Methodist University Hospital, Baptist Memorial Hospital, Vanderbilt University and the Sickle Cell Foundation of Tennessee, will jointly develop, assess and integrate mobile health applications to manage hydroxyurea treatments in the patient community.
"While we have made good progress using hydroxyurea to help children and younger adults look after their disease, much remains to be done to slow the progress of sickle cell as older teenagers transition to adult life," said Jane Hankins, M.D., an associate member of the St. Jude Department of Hematology and Principal Investigator of the project. "Our goal with this project is to use mobile health applications to help 15-year-old and older patients in the Memphis and wider areas manage sickle cell. This is crucial since at this time in their lives they often have less access to healthcare providers and comprehensive sickle cell programs which greatly impacts their quality of life."

The funding from the NIH will be used to identify barriers to medical care and any constraints on the proper use of hydroxyurea by patients in the Memphis and greater Memphis areas. In addition to helping design, test and implement the new mobile health app to improve medication access and adherence, the team will also make the findings of the study available nationwide to encourage best practice and wider use of hydroxyurea in the national sickle cell community.
"We want to have an impact across the country," Hankins said. "Our starting point for this mobile health project is its potential impact on the patients we want to reach," said Hankins. "The widespread availability of mobile phones in our patient community makes for an ideal communication channel to deliver messages that will help patients take hydroxyurea at the right time. It will also provide important other information on the disease and tips on how to stay healthy."

A pilot project conducted at St. Jude demonstrated that text messages improved adherence rates for hydroxyurea by more than 15%.

Hydroxyurea can greatly reduce some of the complications of sickle cell disease by enhancing the production of fetal hemoglobin, a healthy form of the essential oxygen-carrying molecule in red blood cells. St. Jude Children's Research Hospital has pioneered the use of hydroxyurea as an effective treatment for sickle cell disease in children and younger adults. However some studies have shown that only 15-35 percent of sickle cell patients adequately follow their prescribed medication schedules.

Sickle cell disease often affects vulnerable, low-income populations. In the United States, more than 100,000 people are affected, mostly African Americans, many from disadvantaged backgrounds. In the Mid-South region alone sickle cell disease affects approximately 2,000 individuals. If not treated effectively sickle cell disease can lead to organ failure and early death.

Hankins was recently appointed leader of the Methodist Comprehensive Sickle Cell Center at Methodist University Hospital, a joint initiative between St. Jude and Methodist University Hospital to enhance evidence-based clinical care for older sickle cell patients and offer support for further research into the disease.

A research team led by Lisa Klesges, Ph.D., professor at the University of Memphis, will develop the app and measure the population impact of its implementation.

"We have assembled a multidisciplinary team of statisticians, epidemiologists and informaticians who will involve patients in the design of the new app and work closely with all collaborators to optimize the design and measure its use within the community system of care," Klesges said.

In addition, a team led by William Cooper, M.D., M.P.H., professor at Vanderbilt University, will use administrative healthcare insurance data from Medicare, TennCare, and a commercial payer to map existing use of hydroxyurea in the Memphis area. "We are interested in understanding patterns of hydroxyurea use by age and providing a baseline for the findings of the clinical study," Cooper said.

Patients will be recruited and participate at four clinical centers - St. Jude, Methodist University Hospital, Baptist Memorial Hospital, and from the private practice of Dr. Curtis Owens in the Memphis community.

The team will measure the impact of the program and collect all of the data needed to assess the app's effectiveness. The goal is to look at how many patients have adopted the technology and assess its reach, cost effectiveness and longer-term sustainability.

The desired outcome is to share the findings nationwide to make sure that sickle cell patients in this vulnerable age group have the best possible access to the most effective drug treatments.