Development of a Patient-Centred Pharmaceutical Care Framework for Sickle Cell Disease Management in Lagos

Sickle cell disease is highly prevalent in Nigeria, and patients with this condition require coordinated, lifelong pharmaceutical care that extends beyond episodic pain crisis management. This study developed a patient-centred pharmaceutical care framework for sickle cell disease management at sickle cell clinics in Lagos, South West Nigeria. A programme development approach combining patient and provider needs assessment, literature synthesis, and expert consensus was used. Needs assessment interviews were conducted with 40 adult SCD patients and 20 healthcare providers at two sickle cell clinics in Lagos. Key pharmaceutical care deficiencies identified included inconsistent hydroxyurea monitoring, inadequate prophylactic penicillin counselling, poor management of medication-related complications, and limited psychosocial pharmaceutical support. A systematic review of pharmaceutical care models for SCD from sub-Saharan African and diasporic settings informed framework design. The patient-centred framework encompasses seven pharmaceutical care components: comprehensive medication review and reconciliation at each clinic visit, hydroxyurea initiation and monitoring protocol, adherence support and motivational interviewing, pain crisis management pharmacotherapy optimisation, folic acid and iron supplementation guidance, infection prophylaxis management, and transition of care support from paediatric to adult services. Delphi consensus with 15 haematology pharmacists and physicians validated 92 percent of framework components. The study recommends formal adoption of the framework as the pharmaceutical care standard across all Lagos State sickle cell clinics and calls for dedicated pharmacist posts in sickle cell disease teams.

Keywords: sickle cell disease, pharmaceutical care framework, Lagos, patient-centred care, hydroxyurea monitoring