Expanding Access to Hematologists Via Telehealth for People with Sickle Cell Disease

Introduction

Sickle cell disease is a chronic illness that can affect nearly every organ system, requiring complex and multi-disciplinary specialty care. Hematologists play a pivotal role in managing complications such as anemia and iron overload, medication management, and helping patients understand new treatment options, including gene therapy. However, access to hematologic care is often limited. In South Carolina, a state with a significant rural population, there has historically been a lack of engagement with hematologists among the sickle cell population. To address this gap, the Medical University of South Carolina has initiated a telehealth program aimed at expanding care for individuals with sickle cell disease.

Methods

Patients can schedule appointments with the telehealth team through the Medical University of South Carolina via their internal medicine physician, palliative care team, or during inpatient hospitalizations. Additionally, patients can make appointments independently through a web portal. The telehealth visits are conducted using the ThinkAndor® system. Due to licensing restrictions, patients must be physically present in South Carolina at the time of their appointment. The program has been operational for nine months, during which 169 appointments have been made. A random sample of 50 appointments was analyzed, with data collected on the following variables:

• Age of the patient

• Gender of the patient

• Whether patients were actively receiving hydroxyurea

• Success of telehealth visit completion on the initial attempt

• Previous hematologist consultations within the past year

Results

The patient cohort was characterized as follows:

• The average age was 48 years (range: 25-68 years)

• 32 out of 50 patients were over 40 years old

• The gender distribution was equal, with 25 males and 25 females

• 16 out of 50 patients (32%) were either on or recently prescribed hydroxyurea

• 9 out of 50 patients (18%) had seen a hematologist within the previous year, with seven visits occurring during a hospital stay and two being outpatient visits

Utilization of Technology

• 38 out of 50 patients (76%) were able to connect and complete a visit on their initial attempt

• Patients over 40 years old successfully completed a visit 27 out of 32 times (84%)

• Patients 40 years old and under successfully completed a visit 11 out of 18 times (61%)

Discussion

This sample indicated that very few patients had seen a hematologist within one year of their telehealth appointment. Hydroxyurea, a critical medication for preventing sickle cell complications, was underutilized, likely due to limited contact with hematologists. The telehealth program successfully expanded access to care, with a higher success rate among patients over 40. Eventual visits with the younger patients revealed a general lack of understanding of the complexities of sickle cell disease and the necessity of hematologic care, rather than facing technological challenges.

Conclusion

Telehealth visits have proven successful in expanding access to care for the South Carolina sickle cell population.

Landau:Sanofi: Speakers Bureau; pfizer: Speakers Bureau.