Acceptability and compliance with two forms of cholestyramine in the treatment of hypercholesterolemia in children: A randomized, crossover trial

McCrindle, Brian W.; O’Neill, Michael B; Cullen-Dean, Geraldine; Helden, Elizabeth

doi:10.1016/s0022-3476(97)70353-6

Cited by 82 publications

(63 citation statements)

References 22 publications

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“…Thus, it is unsurprising that, despite the availabilityof effective cholesterol-lowering drugs, many patients do not take their medication as prescribed. Studies have reported that between 25 and 70% of patients take fewer doses of their cholesterol-lowering medication than prescribed (Bruckert, Simonetta, & Giral, 1999;Furmaga, 1993;McCrindle, O'Neill, Cullen-Dean, & Helden, 1997;Maenpaa, Manninen, & Heinonen, 1992;Piñ iero et al, 1998).…”

Section: Predictors Of Medication Adherencementioning

confidence: 99%

Cholesterol control, medication adherence and illness cognition

Brewer

Chapman

Brownlee

et al. 2002

British J Health Psychol

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Objective. To examine the relation between illness cognitions and two measures of adherence in patients with hypercholesterolaemia, a disease marked by chronically high cholesterol.Design. Cross-sectional. Based on the self-regulation model (Leventhal, Diefenbach, & Leventhal, 1992), patients' illness cognitions were predicted to be related to cholesterol control and medication adherence. Patients with illness cognitions consonant with an experts' mental model of hypercholesterolaemia were expected to show better control and adherence.Method. Hypercholesterolaemic patients (N = 169) were recruited at a universitybased general medicine clinic. Patients completed a survey that assessed beliefs about hypercholesterolaemia and medication-taking behaviour. Cholesterol levels were obtained from patients' medical charts.Results. Low-density lipoprotein (LDL) cholesterol control was related to believing that hypercholesterolaemia is a stable, asymptomatic disease with severe coronary consequences, and self-report of medication adherence was related to believing that the disease has severe coronary consequences ( ps < .05). LDL cholesterol differences between groups low and high in various illness beliefs ranged between 0.04 and 0.24 mmol/l (2 and 9 mg/dl) which translated to between 1% and 18% lower LDL cholesterol levels.Conclusion. The present study shows several relations that have not been previously demonstrated between better LDL cholesterol control and illness cognition, cognitions that were similar to an expert or physician' s mental model of hypercholesterolaemia. The magnitude of differences in patient cholesterol levels was small but may be clinically important.Coronary heart disease is caused by a number of factors, including elevated cholesterol levels (Knopp, 1999). Patients diagnosed with chronically elevated blood cholesterol

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Section: Predictors Of Medication Adherencementioning

confidence: 99%

Cholesterol control, medication adherence and illness cognition

Brewer

Chapman

Brownlee

et al. 2002

British J Health Psychol

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“…These agents are believed to be safe because they are not systemically absorbed. However, gastrointestinal adverse effects are common, and both acceptability and compliance are poor (1)(2)(3). We have previously shown that compliance is unrelated to patient characteristics, attitudes, and perceptions (2).…”

Section: Discussionmentioning

confidence: 99%

“…However, gastrointestinal adverse effects are common, and both acceptability and compliance are poor (1)(2)(3). We have previously shown that compliance is unrelated to patient characteristics, attitudes, and perceptions (2). Studies with the statins, specifically simvastatin (4), pravastatin (5), and lovastatin (6,7), have shown good reductions in LDL cholesterol with modest elevations in HDL cholesterol.…”

Section: Discussionmentioning

confidence: 99%

“…Children with familial hyperlipidemias often have very high lipid levels, and in the great majority, fat-and cholesterol-restricted dietary therapy alone is insufficient to lower levels into the desired target range. Drug treatment with the bile acid-binding resins also does not sufficiently lower levels, and is associated with poor acceptability and compliance, especially in children (1)(2)(3). The use of the HMG CoA reductase inhibitors, or statins, is controversial in children, related to concerns regarding long-term safety, cost-effectiveness, and efficacy in terms of reducing clinical disease or events, although there are now several studies documenting effectiveness in lipid lowering and short-term safety (4 -7).…”

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confidence: 99%

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A Randomized Crossover Trial of Combination Pharmacologic Therapy in Children with Familial Hyperlipidemia

et al. 2002

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We sought to determine whether a low-dose combination of a bile acid-binding resin (colestipol) with an hydroxymethylglutaryl CoA reductase inhibitor (pravastatin) would result in improved acceptability, compliance, and effectiveness in lipidlowering compared with conventional therapy with a higher dose of a bile acid-binding resin only, with fewer side effects. We performed a randomized, crossover open-label clinical trial with two 18-wk medication regimens separated by an 8-wk washout period in 36 children and adolescents with familial hypercholesterolemia or familial combined hyperlipidemia. The regimens included colestipol 10 g/d (10 pills) versus a combination of colestipol 5 g/d with pravastatin 10 mg/d (six pills). All patients were maintained on a fat-reduced diet. Acceptability was better with the combination regimen. Mean compliance was similar and suboptimal (approximately 60%) with all medication components. Mean relative LDL cholesterol lowering was significantly better with the combination regimen (Ϫ17 Ϯ 16% versus Ϫ10 Ϯ 13%; p ϭ 0.045), although insufficient to achieve recommended target values in the majority of patients on either regimen. Both regimens were equally free of adverse effects, with no important effect on chemistry or hematologic values. Patient-reported adverse effects were more common with the conventional-dose colestipol-only regimen. Compliance with medication regimens using the bile acid-binding resins is suboptimal, although combination with a low dose of a statin may result in better lipid lowering. There is an extensive literature now documenting the effects of lipid-lowering pharmacologic therapy in reducing atherosclerotic cardiovascular disease and events in adults. Children with familial hyperlipidemias often have very high lipid levels, and in the great majority, fat-and cholesterol-restricted dietary therapy alone is insufficient to lower levels into the desired target range. Drug treatment with the bile acid-binding resins also does not sufficiently lower levels, and is associated with poor acceptability and compliance, especially in children (1-3). The use of the HMG CoA reductase inhibitors, or statins, is controversial in children, related to concerns regarding long-term safety, cost-effectiveness, and efficacy in terms of reducing clinical disease or events, although there are now several studies documenting effectiveness in lipid lowering and short-term safety (4 -7). Given the long-term nature of therapy, compliance is one central issue. Also, there are no published data regarding short-term safety and effectiveness of combination drug therapy in hyperlipidemic children.We sought to determine whether a low-dose combination of a bile acid-binding resin (colestipol) with pravastatin would result in improved acceptability, compliance, and short-term effectiveness in lipid lowering compared with conventional therapy with a higher dose of colestipol only, with fewer side effects. We also sought to determine short-term safety and effectiveness of combination drug thera...

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“…Although 75% to 100% of children have been reported [47][48][49] to express a preference for one form over another (eg, sprinkles vs syrup), only 1 of these trials measured compliance. From the parental perspective, earlier studies reported that parents prefer oral liquid to solid forms (eg, powder, tablets, capsules), but compliance was measured in only some studies.…”

Section: Durationmentioning

confidence: 99%

How Do You Improve Compliance?

et al. 2005

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ABSTRACT. Compliance, or adherence, as it relates to health care is the extent to which a person's behavior coincides with medical or health advice. Medication compliance is critical for all aspects of pediatrics, specifically in successful treatment, disease prevention, and health promotion. Compliance depends on the patient's and physician's committing to the same objectives. It is unfortunate that numerous studies and physician accounts reveal difficulties in achieving compliance with pediatric medication therapy. Medication compliance in pediatric patients ranges from 11% to 93%. At least one third of all patients fail to complete relatively short-term treatment regimens. Poor compliance places children at risk for problems such as continued disease, complicates the physician-patient relationship, and prevents accurate assessment of the quality of care provided. This article presents the issue in the context of its incidence of and barriers to compliance and provides general principles to improve compliance in pediatrics by improving communication and characteristics of the practice setting. A oneon-one relationship between physician and patient is needed for communication and improved compliance. T his article is based on reviews of medical literature concerning compliance issues, on information gathered by the American Academy of Pediatrics (AAP) Taskforce on Medication Compliance, the AAP Periodic Survey (no. 44), and personal clinical experiences of the authors.As we begin the 21st century, the average medication compliance is ϳ50% in the pediatric population. 1 The range is from 5% to 15% for urban adolescent medication compliance to 85% to 95% for suburban newborn immunization compliance. There are a host of factors that affect medication compliance, but key among them include social and economic circumstances, particularly health literacy, patient belief systems, patient education, acceptability and palatability of the medication, and adverse effects of the medication. The costs of noncompliance to the health care are not trivial. Although not pediatric specific, the National Pharmaceutical Council estimated that $8.5 billion is unnecessarily spent annually on hospitalizations and physician visits caused by noncompliance to prescription regimens. 2 In pediatrics, it is necessary to deal with not only the issues of the patient but also the issues of the parent or other caregiver, which adds to the complexity of medication compliance.Medication compliance was well reviewed by Jones 3 in 1983, and little has changed since then in terms of medication issues. However, compliance issues are changing because dramatic shifts in the financing and organizing of health care already exert a negative effect on medication compliance. In response to increasing health care costs, particularly for prescription drugs, employers are instituting more restrictive formularies and shifting more of the costs to the employee through such innovations as multitiered copay systems. It remains to be seen whether parents who are f...

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Acceptability and compliance with two forms of cholestyramine in the treatment of hypercholesterolemia in children: A randomized, crossover trial

Cited by 82 publications

References 22 publications

Cholesterol control, medication adherence and illness cognition

Cholesterol control, medication adherence and illness cognition

A Randomized Crossover Trial of Combination Pharmacologic Therapy in Children with Familial Hyperlipidemia

How Do You Improve Compliance?

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