Each month, Clinical Advisor makes one new clinical feature available ahead of print. Don’t forget to take the poll and leave comments. The results will be published in the next month’s issue.

At a glance

  • In children and adolescents with chronic health problems, medication adherence averages about 50%.

    Continue Reading

  • The token reinforcement system is the most frequently used intervention to improve poor adherence in children.

  • Using the simplest regimen that has been proven effective is key to better adherence.

  • Measurement of adherence in children relies on responses to questions by parents, caregivers, and teachers.

How often do you encounter medication noncompliance among patients in your practice?

Anyone who has seen a parent or other caregiver struggling to give medication to a child who has his or her lips tightly closed understands the challenge of medication adherence in the pediatric population. Achieving full adherence in young patients requires not only the cooperation of the child but also a devoted, persistent and adherent parent or caregiver. Additionally, as the child ages and becomes an adolescent, unique developmental, psychosocial and lifestyle issues can create an even greater challenge.1

In children and adolescents with chronic health problems, medication adherence averages about 50%.2 Factors that affect medication adherence in children often revolve around family dynamics, including the hassles of daily living, stress, typical family conflict and the hectic schedules of patients from age 5 years to the early teens.1

Patient factors

Research on adherence has typically focused on the barriers patients face in taking medications. However, the most common barriers to adherence are under the patients’ control, and therefore, calling attention to modifiable barriers is a necessary and important step in improving outcomes.

Reasons most cited by parents who are coping with children and poor adherence include forgetfulness (30%), other priorities (16%), decision to omit doses (11%), lack of information (9%) and emotional factors (7%). The remaining 27% of parents were unable to provide a reason for poor adherence, although they acknowledged that the problem existed.3

Parents have voiced frustration with the current health-care system, in part blaming it for poor adherence. Barriers, such as limited access to health care; restrictive formularies; switching from one formulary to another; and prohibitively high costs for drugs, copayments, or both, pose obstacles to adherence.  

The clinician’s role

Clinicians may also be responsible for some of the frustration felt by parents and caregivers. Among the factors thought to contribute to problems with medication adherence and attributable to clinicians are:

  • Prescribing complex medication regimens
  • Failing to provide adequate explanation of the benefits and side effects of a medication
  • Not giving consideration to the patient’s lifestyle
  • Not considering the cost of medications when prescribing.
  • Having a poor therapeutic relationship with patients.4

Research on proper medication administration and adherence demonstrates that following a regimen exactly as prescribed does work. Studies performed on individuals with such chronic illnesses as asthma and juvenile rheumatoid arthritis reveal an almost 70% improvement in symptoms and control of exacerbations with proper medication adherence.4 This finding reinforces the importance of educating the patient and continuing to work on eliminating barriers.