Journal d'hématologie et des maladies thromboemboliques
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Factors that Predict Outpatient Department Utilization amongst Sickle Cell Disease Patients in the USA

Olamide Oyenubi, Oyintayo Ajiboye, Sophie M Lanzkron and Robert Bollinger

Individuals with sickle cell disease (SCD) frequently present in the emergency room due to various complications that may arise from their condition. Optimal healthcare for people with SCD utilizes outpatient department (OPD) diagnostic and preventive care services. This paper investigates the factors associated with OPD visits compared to Emergency department (ED) visits in patients with SCD. SCD-related OPD visits and ED visits were obtained from the openly available National Hospital Ambulatory Medical Care Survey (NHAMCS) and National Ambulatory Medical Care Survey (NAMCS) data for the years 2009-2010. A total of 822,353 weighted visits by people with SCD were analyzed. Descriptive data include patient demographics, geographical location, and socioeconomic status associated with hospital OPD visits. Of the 812,366 weighted visits, 361,024 were made to the ED and 451,342 were made to the OPD. The median predicted probability of using the OPD amongst patients with SCD was 50%. We found that patients with SCD who had a below median probability of using OPD services were mostly female (66.12%), African-American (98.35%), Medicaid-insured (61.98%) and between the ages of 20-30 years old (42.98%). Individuals with SCD residing in neighborhoods with average income below $52,000 (96.69%), more than 10% below poverty level (86.55%) and less than 20% with a bachelor degree or higher (63.87%) made up the majority of people with below median probability of making OPD visits. This study suggests that there are sociodemographic differences in the utilization of outpatient services amongst people with SCD. Efforts at improving OPD use amongst patients with sickle cell disease should target these patients.