Effect of Counselling on Compliance of Hydroxyurea Therapy and Frequency of Hospital Admissions among Patients with Sickle Cell Disease- A Longitudinal Study

Abstract

Introduction: Sickle Cell Disease (SCD) is an autosomal recessive multisystem disorder, characterised by anaemia, recurrent episodes of pain and chronic organ damage. Hydroxyurea (HU), a disease modifying agent with proven efficacy in reducing painful episodes in SCD patients thereby improving quality of life. Compliance to hydroxyurea therapy is a liming factor in management of SCD. Aim: To compare adherence to HU therapy and frequency of hospital admissions before and after counselling. Materials And Methods: This longitudinal study was conducted in Department of Paediatrics at Gandhi Medical College and associated Hamidia Hospital Bhopal, Madhya Pradesh, India, from 1st January 2020 to 30th June 2021. Patients with SCD, between the age group of 1-14 years, in a study period were recruited for the study. After enrolment, data regarding HU therapy and admissions in the previous one year was recorded for each registered patient. This was followed by detailed counselling sessions, which were repeated at 3 monthly intervals for a period of 1 year. Post-counselling data collection was done to evaluate the response. The effect of counselling was assessed using Chi-square test (for categorical variables) and Analysis of Variance (ANOVA) or paired t-test (for continuous variables). A p-value<0.05 was considered statistically significant. Results: Initially, a total of 42 patients were registered, out of which only 31 patients could be followed-up till the last counselling. Mean age of the patients was 7.8±3.5 years, and 20 (64.5%) cases were males. As per history and previous year data total of 26 (83%) patients were already on HU therapy. Frequency of crises, hospital admissions, school absenteeism, and blood transfusion reduced significantly post counselling. The common factor associated with non adherence to therapy were non availability of drugs 21 (67.7%), followed by improper follow-up 20 (64.5%) and unawareness 17 (54.8%). Financial problems, non-palatability and distance from the hospital were other associated factors in 11 (35.5%), 4 (12.9%) and 2 (6.5%) cases, respectively. Conclusion: With counselling, better drug compliance to HU therapy was observed. This is expected to help in achieving better disease control in terms of reduced need for blood transfusion, hospital admissions as well as school absenteeism.