Addressing Distance As a Barrier to Sickle Cell Care in South Carolina

Introduction:

Adult sickle cell care is often centralized in larger hospital systems, which poses a significant challenge for states with extensive rural areas, such as South Carolina. Limited access to these centralized systems due to distance can be a major barrier to care. Data indicates that many patients are unwilling to travel more than 28 minutes or 20 miles for non-emergency care. We hypothesize that this reluctance contributes to the low percentage of sickle cell patients maintaining relationships with hematologists. To address this issue, the Medical University of South Carolina (MUSC) has initiated a dedicated telehealth program for sickle cell patients. This study aims to evaluate the distances patients would need to travel for traditional in-person hematology care compared to the telehealth option.

Methods:

A previous analysis of our patient population revealed that only 18% of sickle cell patients had consulted a hematologist in the prior year. To assess whether distance acts as a barrier to care, we randomly sampled 25 patient charts of patients who have completed a sickle cell telehealth visit with a hematologist. The 25 patients were sampled at random but the sampling confirmed prior analysis showing a paucity of prior hematologic care for these patients. We used Google Maps® to determine the distance and travel time from each patient's home to MUSC, conducting the search at 8 AM on a weekday to account for peak traffic conditions.

Results:

Our findings indicate that patients generally reside at considerable distances from MUSC. The average distance was 27.8 miles (range: 1.2-96.5 miles), with 56% (14/25) of patients living 20 miles or more from MUSC. At 8 AM, the average travel time was 42 minutes (range: 6-119 minutes), and 68% (17/25) of patients would need at least 30 minutes to reach MUSC.

Discussion:

The low percentage of sickle cell patients in South Carolina with an established relationship with a hematologist is concerning. Our results suggest that distance to care is a significant barrier. The implementation of a telehealth program has effectively mitigated this barrier, facilitating better access to hematology care for sickle cell patients.

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