Recent treatment guidelines for managing adult patients with sickle cell disease: challenges in access to care, social issues, and adherence

References

• Adams-Graves P, Ostric EJ, Martin M, et al. Sickle cell hospital unit: a disease-specific model. J Healthc Manag. 2008;53:305–315.
   PubMed Web of Science ®Google Scholar
• Brousseau DC, Panepinto JA, Nimmer M, et al. The number of people with sickle-cell disease in the United States: national and state estimates. Am J Hematol. 2010;85:77–78.
   PubMed Web of Science ®Google Scholar
• Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med. 2010;38(4):S512–521.
   PubMed Web of Science ®Google Scholar
• Platt OS, Brambilla DJ, Rosse WF, et al. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med. 1994;330:1639–1644.
   PubMed Web of Science ®Google Scholar
• Lanzkron S, Carroll CP, Haywood C Jr. Mortality rates and age at death from sickle cell disease: U.S., 1979–2005. Public Health Rep. 2013;128:110–116.
   PubMed Web of Science ®Google Scholar
• Paulukonis ST, Eckman JR, Snyder AB, et al. Defining sickle cell disease mortality using a population-based surveillance system, 2004 through 2008. Public Health Rep. 2016;131:367–375.
   PubMed Web of Science ®Google Scholar
• Evidence-Based Management of Sickle Cell Disease. Expert Panel Report, 2014. National Institutes of Health. National Heart, Lung, and Blood Institute, 2014. [ cited 2015 Sep 28]. Available from: http://www.nhlbi.nih.gov/health-pro/guidelines/sickle-cell-disease-guidelines.
   Google Scholar
• Yawn BP, Buchanan GR, Afenyi-Annan AN, et al. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA. 2014;312:1033–1048.
   PubMed Web of Science ®Google Scholar
• Neville KA, Panepinto JA. Pharmacotherapy of sickle cell disease. World Health Organization: 18th Expert Committee on the Selection and Use of Essential Medicines, 2011 Mar 21–25. [cited 2015 Sep 28]. Available from: http://www.who.int/selection_medicines/committees/expert/18/applications/Sicklecell.pdf.
   Google Scholar
• Sickle Cell Society. Standards for the clinical care of adults with sickle cell disease in the UK. London: Sickle Cell Society; 2008.
   Google Scholar
• The Management of Sickle Cell Disease. Revised June 2002. NIH Publication No. 02–2117. Bethesda (MD): National Institutes of Health. National Heart, Lung, and Blood Institute. [cited 2015 Sep 28]. Available from: http://www.nhlbi.nih.gov/health/prof/blood/sickle/sc_mngt.pdf.
   Google Scholar
• Charache S, Terrin ML, Moore RD, et al. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med. 1995;332:1317–1322.
   PubMed Web of Science ®Google Scholar
• Brawley OW, Cornelius LJ, Edwards LR, et al. National Institutes of Health Consensus Development Conference statement: hydroxyurea treatment for sickle cell disease. Ann Intern Med. 2008;148:932–938.
   PubMed Web of Science ®Google Scholar
• Klings ES, Machado RF, Barst RJ, et al. American Thoracic Society ad hoc committee on pulmonary hypertension of sickle cell disease. An official American Thoracic Society clinical practice guideline: diagnosis, risk stratification, and management of pulmonary hypertension of sickle cell disease. Am J Respir Crit Care Med. 2014;189:727–740.
   PubMed Web of Science ®Google Scholar
• Centers for Disease Control and Prevention. Prevention and control of Haemophilus influenzae type b disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63(RR–01):1–14.
   Google Scholar
• Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61:816–889.
   PubMedGoogle Scholar
• Centers for Disease Control and Prevention. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR–2):1–28.
   Web of Science ®Google Scholar
• Social Security Disability Help. Sickle cell disease and Social Security disability. 2016. [cited 2016 Apr 4] Available from: http://www.disability-benefits-help.org/disabling-conditions/sickle-cell-disease-and-social-security-disability.
   Google Scholar
• Social Security Disability. 2016. [cited 2016 Apr 4]. Available from https://www.disability.gov.
   Google Scholar
• Labbé E, Herbert D, Haynes J. Physicians’ attitude and practices in sickle cell disease pain management. J Palliat Care. 2005;21:246–251.
   PubMed Web of Science ®Google Scholar
• Ballas SK, Lusardi M. Hospital readmission for adult acute sickle cell painful episodes: frequency, etiology, and prognostic significance. Am J Hematol. 2005;79:17–25.
   PubMed Web of Science ®Google Scholar
• Ballas SK. Sickle cell pain. 2nd ed. Seattle (WA): IASP Press; 2014.
   Google Scholar
• Ballas SK, Gupta K, Adams-Graves P. Sickle cell pain: a critical reappraisal. Blood. 2012;120:3647–3656.
   PubMed Web of Science ®Google Scholar
• Smith WR, Penberthy LT, Bovbjerg VE, et al. Daily assessment of pain in adults with sickle cell disease. Ann Intern Med. 2008;148:94–101.
   PubMed Web of Science ®Google Scholar
• Platt OS, Thorington BD, Brambilla DJ, et al. Pain in sickle cell disease. Rates and risk factors. N Engl J Med. 1991;325:11–16.
   PubMed Web of Science ®Google Scholar
• Kanter J, Kruse-Jarres R. Management of sickle cell disease from childhood through adulthood. Blood Rev. 2013;27:279–287.
   PubMed Web of Science ®Google Scholar
• Bean CJ, Hooper WC, Ellingsen D, et al. Discordance between self-report and genetic confirmation of sickle cell disease status in African-American adults. Public Health Genomics. 2014;17:169–172.
   PubMed Web of Science ®Google Scholar
• Strouse JJ, Jordan LC, Lanzkron S, et al. The excess burden of stroke in hospitalized adults with sickle cell disease. Am J Hematol. 2009;84:548–552.
   PubMed Web of Science ®Google Scholar
• Gueguen A, Mahevas M, Nzouakou R, et al. Sickle-cell disease stroke throughout life: a retrospective study in an adult referral center. Am J Hematol. 2014;89:267–272.
   PubMed Web of Science ®Google Scholar
• Gosmanova EO, Zaidi S, Wan JY, et al. Prevalence and progression of chronic kidney disease in adult patients with sickle cell disease. J Investig Med. 2014;62:804–807.
   PubMed Web of Science ®Google Scholar
• McClellan AC, Luthi JC, Lynch JR, et al. High one year mortality in adults with sickle cell disease and end-stage renal disease. Br J Haematol. 2012;159:360–367.
   PubMed Web of Science ®Google Scholar
• Vichinsky EP, Styles LA, Colangelo LH, et al. Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease. Blood. 1997;89:1787–1792.
   PubMed Web of Science ®Google Scholar
• Mehari A, Alam S, Tian X, et al. Hemodynamic predictors of mortality in adults with sickle cell disease. Am J Respir Crit Care Med. 2013;187:840–847.
   PubMed Web of Science ®Google Scholar
• Gladwin MT, Sachdev V, Jison ML, et al. Pulmonary hypertension as a risk factor for death in patients with sickle cell disease. N Engl J Med. 2004;350:886–895.
   PubMed Web of Science ®Google Scholar
• Koshy M, Entsuah R, Koranda A, et al. Leg ulcers in patients with sickle cell disease. Blood. 1989;74:1403–1408.
   PubMed Web of Science ®Google Scholar
• Delaney KM, Axelrod KC, Buscetta A, et al. Leg ulcers in sickle cell disease: current patterns and practices. Hemoglobin. 2013;37:325–332.
   PubMed Web of Science ®Google Scholar
• Berry PA, Cross TJ, Thein SL, et al. Hepatic dysfunction in sickle cell disease: a new system of classification based on global assessment. Clin Gastroenterol Hepatol. 2007;5:1469–1476.
   PubMed Web of Science ®Google Scholar
• Alayed N, Kezouh A, Oddy L, et al. Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births. J Perinat Med. 2014;42:487–492.
   PubMed Web of Science ®Google Scholar
• Berthaut I, Guignedoux G, Kirsch-Noir F, et al. Influence of sickle cell disease and treatment with hydroxyurea on sperm parameters and fertility of human males. Haematologica. 2008;93:988–993.
   PubMed Web of Science ®Google Scholar
• Mantadakis E, Cavender JD, Rogers ZR, et al. Prevalence of priapism in children and adolescents with sickle cell anemia. J Pediatr Hematol Oncol. 1999;21:518–522.
   PubMed Web of Science ®Google Scholar
• Adeyoju AB, Olujohungbe AB, Morris J, et al. Priapism in sickle-cell disease; incidence, risk factors and complications – an international multicentre study. BJU Int. 2002;90:898–902.
   PubMed Web of Science ®Google Scholar
• Sharpsteen JR Jr, Powars D, Johnson C, et al. Multisystem damage associated with tricorporal priapism in sickle cell disease. Am J Med. 1993;94:289–295.
   PubMed Web of Science ®Google Scholar
• Milner PF, Kraus AP, Sebes JI, et al. Sickle cell disease as a cause of osteonecrosis of the femoral head. N Engl J Med. 1991;325:1476–1481.
   PubMed Web of Science ®Google Scholar
• Allareddy V, Roy A, Lee MK, et al. Outcomes of acute chest syndrome in adult patients with sickle cell disease: predictors of mortality. PLoS One. 2014;9:e94387.
   PubMed Web of Science ®Google Scholar
• Elmariah H, Garrett ME, De Castro LM, et al. Factors associated with survival in a contemporary adult sickle cell disease cohort. Am J Hematol. 2014;89:530–535.
   PubMed Web of Science ®Google Scholar
• Gladwin MT, Barst RJ, Gibbs JS, et al. Walk-PHaSST investigators and patients. Risk factors for death in 632 patients with sickle cell disease in the United States and United Kingdom. PLoS One. 2014;9:e99489.
   PubMed Web of Science ®Google Scholar
• Darbari DS, Wang Z, Kwak M, et al. Severe painful vaso-occlusive crises and mortality in a contemporary adult sickle cell anemia cohort study. PLoS One. 2013;8:e79923.
   PubMed Web of Science ®Google Scholar
• Steinberg MH, McCarthy WF, Castro O, et al. Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia and MSH patients’ follow-up. The risks and benefits of long-term use of hydroxyurea in sickle cell anemia: a 17.5 year follow-up. Am J Hematol. 2010;85:403–408.
   PubMed Web of Science ®Google Scholar
• Olivieri NF. Progression of iron overload in sickle cell disease. Semin Hematol. 2001;38(1 Suppl 1):57–62.
   PubMed Web of Science ®Google Scholar
• Meloni A, Puliyel M, Pepe A, et al. Cardiac iron overload in sickle-cell disease. Am J Hematol. 2014;89:678–683.
   PubMed Web of Science ®Google Scholar
• Ballas SK. Iron overload is a determinant of morbidity and mortality in adult patients with sickle cell disease. Semin Hematol. 2001;38(1 Suppl 1):30–36.
   PubMed Web of Science ®Google Scholar
• Andrews NC. Disorders of iron metabolism. N Engl J Med. 1999;341:1986–1995.
   PubMed Web of Science ®Google Scholar
• Porter JB. Practical management of iron overload. Br J Haematol. 2001;115:239–252.
   PubMed Web of Science ®Google Scholar
• Kanter J, Kruse-Jarres R. Management of sickle cell disease from childhood through adulthood. Blood Rev. 2013;27:279–287.
   PubMed Web of Science ®Google Scholar
• Darbari DS, Kple-Faget P, Kwagyan J, et al. Circumstances of death in adult sickle cell disease patients. Am J Hematol. 2006;81:858–863.
   PubMed Web of Science ®Google Scholar
• Kremastinos DT, Tsetsos GA, Tsiapras DP, et al. Heart failure in beta thalassemia: a 5-year follow-up study. Am J Med. 2001;111:349–354.
   PubMed Web of Science ®Google Scholar
• Pennell DJ, Udelson JE, Arai AE, et al. American Heart Association Committee on Heart Failure and Transplantation of the Council on Clinical Cardiology and Council on Cardiovascular Radiology and Imaging. Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation. 2013;128:281–308.
   PubMed Web of Science ®Google Scholar
• 2013 National Healthcare Disparities Report. AHRQ Publication No. 14–0006. Agency for Healthcare Research and Quality. [ updated 2014 May; cited 2015 Sep 28]. Available from: http://www.ahrq.gov/research/findings/nhqrdr/index.html.
   Google Scholar
• Centers for Disease Control and Prevention. CDC health disparities and inequalities report – United States, 2011. MMWR. 2011;60(Suppl):1–113.
   Google Scholar
• Centers for Disease Control and Prevention. CDC health disparities and inequalities report – United States, 2013. MMWR. 2013;62(Suppl 3):1–186.
   PubMed Web of Science ®Google Scholar
• Wolfson JA, Schrager SM, Khanna R, et al. Sickle cell disease in California: sociodemographic predictors of emergency department utilization. Pediatr Blood Cancer. 2012;58:66–73.
   PubMed Web of Science ®Google Scholar
• Telfair J, Haque A, Etienne M, et al. Rural/urban differences in access to and utilization of services among people in Alabama with sickle cell disease. Public Health Rep. 2003;118:27–36.
   PubMed Web of Science ®Google Scholar
• Blinder MA, Vekeman F, Sasane M, et al. Age-related treatment patterns in sickle cell disease patients and the associated sickle cell complications and healthcare costs. Pediatr Blood Cancer. 2013;60:828–835.
   PubMed Web of Science ®Google Scholar
• Boyle CA, Gracia JN. Changing the prognosis for sickle cell disease through the Affordable Care Act. [ updated 2013 Sep 27; cited 2015 Sep 28]. Blog: National Partnership for Action. Available from: http://www.minorityhealth.hhs.gov/npa/blog/BlogPost.aspx?BlogType=P&BlogID=3016.
   Google Scholar
• Nelson SC, Hackman HW. Race matters: perceptions of race and racism in a sickle cell center. Pediatr Blood Cancer. 2013;60:451–454.
   PubMed Web of Science ®Google Scholar
• Haywood C Jr, Diener-West M, Strouse J, et al. IMPORT Investigators. Perceived discrimination in health care is associated with a greater burden of pain in sickle cell disease. J Pain Symptom Manage. 2014;48:934–943.
   PubMed Web of Science ®Google Scholar
• Haywood C Jr, Bediako S, Lanzkron S, et al. For the IMPORT Investigators. An unequal burden: poor patient–provider communication and sickle cell disease. Patient Educ Couns. 2014;96:159–164.
   PubMed Web of Science ®Google Scholar
• Wilper AP, Woolhandler S, Lasser KE, et al. Waits to see an emergency department physician: U.S. trends and predictors, 1997–2004. Health Aff (Millwood). 2008;27:w84–w95.
   PubMed Web of Science ®Google Scholar
• Haywood C Jr, Tanabe P, Naik R, et al. The impact of race and disease on sickle cell patient wait times in the emergency department. Am J Emerg Med. 2013;31:651–656.
   PubMed Web of Science ®Google Scholar
• HHS Announces Sickle Cell Disease Initiative. Bethesda (MD): National Institutes of Health. National Heart, Lung, and Blood Institute, Office of the Director. 2011. [cited 2015 Sep 28]. Available from: http://www.nhlbi.nih.gov/about/directorscorner/messages/2009-2012-shurin/hhs-announces-sickle-cell-disease-initiative.html#.
   Google Scholar
• Sickle Cell Disease, About Us. Centers for Disease Control and Prevention. National Center on Birth Defects and Developmental Disabilities (NCBDDD), 2014. [cited 29 Sep 2015]. Available from: http://www.cdc.gov/ncbddd/sicklecell/about.html.
   Google Scholar
• Sickle Cell Disease, Data & Statistics. Centers for Disease Control and Prevention. National Center on Birth Defects and Developmental Disabilities (NCBDDD), 2015. [cited 2015 Sep 29]. Available from: http://www.cdc.gov/ncbddd/sicklecell/data.html.
   Google Scholar
• RuSH Strategies From the Field: Data Collection. Centers for Disease Control and Prevention. National Center on Birth Defects and Developmental Disabilities (NCBDDD), 2014. [cited 29 Sep 2015]. Available from: http://www.cdc.gov/ncbddd/hemoglobinopathies/rush.html.
   Google Scholar
• Kauf TL, Coates TD, Huazhi L, et al. The cost of health care for children and adults with sickle cell disease. Am J Hematol. 2009;84:323–327.
   PubMed Web of Science ®Google Scholar
• Blinder MA, Sasane M, Fortier J, et al. High cost patients and cost patterns from pediatric to adult care in a Medicaid population with sickle cell disease. Presented at: International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 19th Annual International Meeting; 2014 May 31–June 4; Montreal, QC. Abstract PHS71.
   Google Scholar
• Steiner CA, Miller JL. Sickle Cell Disease Patients in U.S. Hospitals, 2004. HCUP Statistical Brief #21. December 2006. Agency for Healthcare Research and Quality, Rockville, MD. [cited 2015 Sep 29]. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb21.pdf.
   Google Scholar
• Brousseau DC, Owens PL, Mosso AL, et al. Acute care utilization and rehospitalizations for sickle cell disease. JAMA. 2010;303:1288–1294.
   PubMed Web of Science ®Google Scholar
• Candrilli SD, O’Brien SH, Ware RE, et al. Hydroxyurea adherence and associated outcomes among Medicaid enrollees with sickle cell disease. Am J Hematol. 2011;86:273–277.
   PubMed Web of Science ®Google Scholar
• Vekeman F, Sasane M, Cheng WY, et al. Adherence to iron chelation therapy and associated healthcare resource utilization and costs in Medicaid patients with sickle cell disease and thalassemia. J Med Econ. 2016;19:292–303.
   PubMed Web of Science ®Google Scholar
• Thakkar J, Kurup R, Laba TL, et al. Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysis. JAMA Intern Med. 2016;176:340–349.
   PubMed Web of Science ®Google Scholar
• Vichinsky E, Onyekwere O, Porter J, et al. A randomised comparison of deferasirox versus deferoxamine for the treatment of transfusional iron overload in sickle cell disease. Br J Haematol. 2007;136:501–508.
   PubMed Web of Science ®Google Scholar
• Novartis Pharmaceuticals Corporation. Exjade [prescribing information]. East Hanover (NJ): Novartis Pharmaceuticals Corporation; 2013.
   Google Scholar
• Armstrong EP, Skrepnek GH, Sasane M, et al. Long-term persistency and costs associated with the use of iron chelation therapies in the treatment of sickle cell disease within Medicaid programs. J Med Econ. 2013;16:10–18.
   PubMedGoogle Scholar
• Jordan LB, Vekeman F, Sengupta A, et al. Persistence and compliance of deferoxamine versus deferasirox in Medicaid patients with sickle-cell disease. J Clin Pharm Ther. 2012;37:173–181.
   PubMed Web of Science ®Google Scholar
• McManus M, Beck D, White P. The National Alliance to Advance Adolescent Health. 2016. [cited 2016 Apr 4]. Available from http://www.gottransition.org/resourceGet.cfm?id=407.
   Google Scholar
• Williams CP, Smith CH, Osborn K, et al. Patient-centered approach to designing sickle cell transition education. J Pediatr Hematol Oncol. 2015;37:43–47.
   PubMed Web of Science ®Google Scholar
• Sobota A, Akinlonu A, Champigny M, et al. Self-reported transition readiness among young adults with sickle cell disease. J Pediatr Hematol Oncol. 2014;36:389–394.
   PubMed Web of Science ®Google Scholar
• Andemariam B, Owarish-Gross J, Grady J, et al. Identification of risk factors for an unsuccessful transition from pediatric to adult sickle cell disease care. Pediatr Blood Cancer. 2014;61:697–701.
   PubMed Web of Science ®Google Scholar
• Hankins JS, Osarogiagbon R, Adams-Graves P, et al. A transition pilot program for adolescents with sickle cell disease. J Pediatr Health Care. 2012;26:e45–49.
   PubMed Web of Science ®Google Scholar
• Jenerette CM, Brewer CA, Edwards LJ, et al. An intervention to decrease stigma in young adults with sickle cell disease. West J Nurs Res. 2014;36:599–619.
   PubMed Web of Science ®Google Scholar
• Cooley WC, Sagerman PJ, American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians; Transitions Clinical Report Authoring Group. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128:182–200.
   PubMed Web of Science ®Google Scholar
• DeBaun MR, Telfair J. Transition and sickle cell disease. Pediatrics. 2012;130:926–935.
   PubMed Web of Science ®Google Scholar
• Grosse SD, Schechter MS, Kulkarni R, et al. Models of comprehensive multidisciplinary care for individuals in the United States with genetic disorders. Pediatrics. 2009;123:407–412.
   PubMed Web of Science ®Google Scholar
• Crosby LE, Quinn CT, Kalinyak KA. A biopsychosocial model for the management of patients with sickle-cell disease transitioning to adult medical care. Adv Ther. 2015;32:293–305.
   PubMed Web of Science ®Google Scholar
• Benjamin LJ, Swinson GI, Nagel RL. Sickle cell anemia day hospital: an approach for the management of uncomplicated painful crises. Blood. 2000;95:1130–1136.
   PubMed Web of Science ®Google Scholar
• Jordan L. AHRQ Health Care Innovations Exchange. Day hospital reduces inpatient length of stay and emergency department visits for patients with sickle cell anemia, 2011. [cited 2015 Sep 29]. Available from: https://innovations.ahrq.gov/profiles/day-hospital-reduces-inpatient-length-stay-and-emergency-department-visits-patients-sickle.
   Google Scholar
• Wilkie DJ, Johnson B, Mack AK, et al. Sickle cell disease: an opportunity for palliative care across the life span. Nurs Clin North Am. 2010;45:375–397.
   PubMed Web of Science ®Google Scholar
• Grady Health. Sickle Cell Center. [cited 2015 Sep 29]. Available from: http://www.gradyhealth.org/specialty/sickle-cell-center.html.
   Google Scholar
• Koch KL, Karafin MS, Simpson P, et al. Intensive management of high-utilizing adults with sickle cell disease lowers admissions. Am J Hematol. 2015;90:215–219.
   PubMed Web of Science ®Google Scholar
• Lanzkron S, Carroll CP, Hill P, et al. Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis. Am J Hematol. 2015;90:376–380.
   PubMed Web of Science ®Google Scholar
• Whiteman LN, Lanzkron S, Stewart RW, et al. Quality improvement process in a sickle cell infusion center. Am J Med. 2015;128:541–544.
   PubMed Web of Science ®Google Scholar
• Jordan L. Day hospital reduces inpatient length of stay and emergency department visits for patients with sickle cell anemia. AHRQ Innovations Exchange. 2011. [cited 2016 Mar 24]. Available from: http://www.innovations.ahrq.gov/content.aspx?id=3100.2011a.
   Google Scholar
• Jordan L. Sickle cell day hospital, a solution that works. National Association of Public Hospitals and Health Systems. 2011. [cited 2016 Mar 24]. Available from http://naph.org/Homepage%20Sections/Explore/Innovations/CareCoordination/Memorial-Regional-Hospital-Sickle-CellInnovation.aspx.2011b.
   Google Scholar
• Lorig KR, Ritter P, Stewart AL, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001;39:1217–1223.
   PubMed Web of Science ®Google Scholar