Medication Adherence in Pediatric and Adolescent Liver Transplant Recipients

Abstract

Our results indicate that clinical impression is not sufficient to determine whether children and adolescents are taking their medications after they have had a liver transplant. An objective assessment method should be used. Interventions targeting adherence should address the child's increasing role beginning in early adolescence. A clinical protocol incorporating objective assessments of adherence could potentially be implemented in other settings. It could form the basis for the evaluation of efficacy of interventions seeking to improve adherence to medications.

The Importance of Adherence and Compliance with Treatment in Cystic Fibrosis

“…As such, the perception that there are no beneficial effects with the treatment is wholesale problem for physiotherapy (Bernard & Cohen, 2004;Conway et al, 1996;Czjkowski et al, 1987;Shemesh et al, 2004;Teichman et al, 2001), and it has been published as being substituted with exercise in 20% of cases, just as we found (20.6%).…”

“…There are also studies that clearly show that clinical impressions are not accurate enough to determine the real therapeutic adherence of patients, and so it would be also convenient to use a more objective method (Marciel et al, 2010;Modi et al;Shemesh et al, 2004). It has been mentioned that the level of adherence could vary according to the subjectivity of the method employed, such as with a personal questionnaire, even if the results are corrected with the opinions of the medical professionals or other objective measures, such as blood-serum levels, the urinary excretion of medications or their metabolites, or the monitoring of adherence with electronic recording devices or the dispensers of medications (Conway et al, 1996;Modi et al, 2006;Rand et al, 1992;Teichman et al, 2000).…”

Compliance of the recurrent renal stone former with current best practice guidelines

“…It has been described that an important factor in noncompliance is patients' inability to remember the details of physician recommendations during clinic visits. [23][24] Even during clinical encounters where information is communicated effectively and comprehension is initially high, much of what is conveyed is often forgotten within moments of leaving the physician's office. 25 Perhaps frequent and effective clinic visits, along with the availability of health promotion literature for the patient, may be a worthwhile consideration during initial stone presentation to optimize preventative stone practices, potentially reducing future patient morbidity.…”

The management of childhood liver diseases in adulthood

“…The first stage of transition in the shared management model begins approximately at 10 years of age and involves the introduction of the concept of transition [7,8]. Over the following years, a slow process ensues of engaging and preparing these young children in becoming independent young adults [7,9].…”

“…Studies performed in adolescent transplant recipients provide information which is transferable to adolescents with chronic liver disease. Current data suggests that up to onethird of adolescents are non-adherent with medication and their clinic visits, leading to worsening liver function and possible organ failure [7,9,19,20]. The prevalence of non-adherence in adolescent transplant recipients can be as high as 50% [20].…”