Abstract TP463: Enhancing Access to Stroke Neurology Care for Patients With Sickle Cell Disease

Introduction: Patients with chronic illness have demonstrated non-adherence rates to clinic appointments ranging between 20-40%, however, few studies have documented non-adherence rates in patients with sickle cell disease. One study estimated that during an 8-month period non-adherence rates were as high as 46%. Patients with sickle cell disease and a history of prior stroke are at particularly high risk of recurrence for secondary stroke requiring routine follow up. This study aimed at examining the effect on non-adherence rates after the development of a combined stroke-sickle cell outpatient clinic. Methods: Non-adherence rates were examined in the separate stroke clinic and compared to the combined outpatient stroke-sickle cell clinic, staffed by a vascular neurology physician, an advanced practice nurse (APN) and a hematology physician. The APN was readily available for consultation and follow-up of patients with a history of stroke, suspected stroke, or transient ischemic attack. Non-adherence rates were calculated based on no show events over total scheduled clinic events. Descriptive statistics were used to compare groups of patients and a Chi-Square was used to compare non adherence between groups. Results: Since September 2015 to August 2018, there was a total of 34 total scheduled clinic visits in the separate stroke clinic, resulting in a non-adherence rate of 26.5%. Since the inception of the combined stroke-sickle cell clinic in September 2016 to August 2018, there was a total of 45 scheduled clinic visits, resulting in a non-adherence rate of 11.1%. The number of new consultations for the stroke clinic and combined clinic were 44.1% and 40.0% respectively. Conclusion: The development of a combined stroke-sickle cell outpatient clinic may be an effective, multidisciplinary method for improving non-adherence rates in patients with sickle cell disease and a history of stroke. In addition, creating a combined clinic both increases patient access for both sickle cell patients at high risk for cerebrovascular disease as well as stroke patients without a history of sickle cell disease.