Embedded Primary Care in Adult Sickle Cell Teams

Key Takeaways

• The embedded model was associated with higher odds of several general preventive and sickle cell-specific care measures.
• Among patients who saw the embedded clinician, annual outpatient visits increased from 2.7 to 4.2 per year.
• Annual inpatient admissions were 1.4 after embedded care versus 1.9 before it without statistical significance, and the authors concluded the overall pattern aligned with more coordinated outpatient-focused management.

At a single tertiary care center, adults with sickle cell disease received primary care from an embedded board-certified internist/pediatric primary care provider within the adult SCD team. Patients exposed to that model had broader preventive care uptake and, among those who saw the embedded clinician, annual outpatient visits increased from 2.7 before embedded primary care to 4.2 after it in this retrospective cohort study. The overall pattern aligned with more preventive and outpatient-focused care within the program.

Investigators evaluated adults with sickle cell disease seen at one tertiary care center from July 2020 to June 2025. The center saw 388 adults with SCD during that interval, and 174 received care from the embedded primary care provider. That clinician was a board-certified internist/pediatric primary care provider who practiced in a comprehensive SCD clinic and participated in operational and educational meetings as a full team member. The evaluation focused on preventive care delivery and healthcare utilization within this embedded model of adult sickle cell care.

Among adults with sickle cell disease, exposure to the embedded model was associated with higher odds of several general preventive measures, including cervical cancer screening (OR 4.49; 95% CI 2.46-8.23), depression screening (OR 7.97; 95% CI 1.78-35.69), and Tdap immunization (OR 2.88; 95% CI 1.72-4.84). For sickle cell-specific care, annual eye examinations had OR 2.59 (95% CI 1.66-4.04), pneumococcal immunization OR 3.58 (95% CI 2.16-5.92), and urine protein screening OR 3.36 (95% CI 1.89-6.00). ACE inhibitor or ARB use for microalbuminuria was also higher, with OR 9.37 (95% CI 3.11-28.23).

Among patients who saw the embedded primary care provider, annual outpatient visits rose from 2.7 before embedded care to 4.2 after it, with p < 0.0001. Annual inpatient admissions were 1.9 before embedded care and 1.4 after it, but that difference was not statistically significant (p = 0.4869). These utilization results were limited to patients who saw the embedded clinician. The authors concluded that the overall pattern was consistent with more coordinated, outpatient-focused management within the program.