Abstract
Background
Sickle cell disease is a genetic condition associated with increased mortality, as well as health complications including pain crises, infection, and stroke. Children with sickle cell anemia (SCA), a subtype of sickle cell disease, are at an especially high risk of infection and stroke. Two key preventive services for this population include daily antibiotic prophylaxis, which reduces the incidence of bacterial infections, and Transcranial Doppler (TCD) screening, which identifies children who should receive chronic exchange transfusions to reduce the risk of stroke. As such, national guidelines recommend that children with SCA receive a daily antibiotic prophylaxis regimen from birth to five years and an annual TCD screen from 2 to 16 years.Objective
Our objective was to evaluate the receipt of antibiotic prophylaxis and TCD screening among children with SCA enrolled in Michigan Medicaid.Methods
Data was acquired from the Michigan Sickle Cell Data Collection (MiSCDC) program, a multi-data source public health surveillance program funded by the CDC. The study population included children with SCA that were continuously enrolled in a full-coverage Michigan Medicaid plan for 12 months, for each respective calendar year between 2018-2022. Within this group, children aged 0-5 were included in evaluation of receipt of antibiotic prophylaxis, and children aged 2-15 were included in evaluation of receipt of TCD. Antibiotic prescription metrics included proportion with at least one filled antibiotic prescription, at least 300 days of filled antibiotic prescription, and average days’ supply of filled antibiotic prescription among those with at least one prescription. For TCD screening, the number of children who received at least one TCD screen annually were stratified by age group (ages 2-5, ages 6-11, and ages 12-15).Results
An annual average of 123 children for antibiotic prophylaxis and 289 children for annual TCD screening were identified from 2018-2022. An average of 87.1% of children received at least one filled antibiotic each year. The proportion of children that received at least 300 days filled antibiotic ranged from a low of 5.3% in 2018 to a high of 16.2% in 2021. Average days’ supply of antibiotic ranged from a low of 145 days in 2019 to a high of 170 days in 2021. Less than half of eligible children received at least one TCD screen annually, with the lowest proportion of 38.0% in 2019. The 12-15 age group had the lowest proportion of children with a TCD screen compared to the other age groups.Conclusion
Despite national recommendations, receipt of preventive services among children with SCA remains low. Further research should be conducted on strategies to improve receipt of antibiotic prophylaxis and TCD screening, to reduce morbidity and mortality within this population.Categories: Conference Abstracts/Posters