Oral Medication Adherence in Pediatric Inflammatory Bowel Disease

Abstract

The purpose of this study was to examine reports of adherence to oral medications, parent-child concordance in reports of adherence, and factors associated with poor adherence in adolescents with inflammatory bowel disease (IBD). Participants were 50 children with IBD 11 to 17 years of age and their parents. Parents completed an adherence interview and the Child Behavior Checklist, Family Assessment Device, and demographics questionnaires. Separately, adolescents completed the adherence interview and the Piers Harris Self-Concept Scale, Children's Depression Inventory, and Coping Strategies Inventory questionnaires. The treating gastroenterologists of participating children completed the Pediatric Crohn's Disease Activity Index during a clinic visit within a week of completion of the questionnaires. Mean parent- and child-reported adherence scores fell between the "most of the time" and "always" categories, although perfect adherence was low. Among IBD-specific medications (5-ASAs, immunomodulators, steroids), 48% of children and 38% of parents reported being always adherent to all medications. Parent-child concordance was high. Family dysfunction and poor child coping strategies were associated with worse adherence. The correlation between more behavioral/emotional problems and lower adherence approached significance. Adherence should be monitored in families that lack appropriate child discipline and in children who cope by simply wishing stressors would go away. Because these issues are associated with poor adherence, it has been suggested that psychotherapy addressing these areas may contribute to improved adherence.

Factors associated with thiopurine non-adherence in patients with inflammatory bowel disease

“…17 Thus, the patients labelled young adults herein are older than those reported in paediatric series. [19][20][21][22][23][24] As a result, we have intentionally drawn comparisons throughout this discussion from the adult literature with similar age ranges. Time constraints, medication side effects, poorly controlled disease activity and the perception that the drug is not working, as well as simply forgetting have been cited by young adults with IBD and their parents as reasons for non-adherence.…”

“…17,18 The reasons for this have not been investigated, because the body of paediatric and/or adolescent literature has focused on children under the age of 17 years. [19][20][21][22][23][24] However, psychological co-morbidity has been implicated as a potentially reversible cause in children 24 and adults with IBD. 11,16,25,26 On the basis of our previous retrospective observations, 18 we hypothesised that non-adherence, objectively defined using thiopurine metabolite levels, is more common in young adults attending our adolescent transition clinic than adults with IBD and that psychological co-morbidity is a contributing factor.…”

The role of family nurse practitioners : promoting oral medication adherence to maintenance treatment among adolescents with inflammatory bowel disease

“…Feelings ofhelplessness, dependency and low self-esteem, anxiety and depressive symptoms can have direct implications on adherence to treatment plans (Mackner & Crandall, 2006). Because these issues are associated with poor adherence, it has been suggested that psychotherapy addressing these areas may contribute to improved medication adherence (Mackner & Crandall, 2005). Given the significance of psychosocial issues associated with the disease and medication adherence among adolescents with ffiD, examination of non-adherence is likely best conceptualized with the BPS model.…”

“…Given that non-adherence rates for maintenance medications in adolescentswith IBD range from 50% to 88% (Hommel et al, 2009;Mackner & Crandall, 2005;Oliva-Hemker at al., 2007) and its considerable impacts on health outcomes and healthcare costs, it is important for healthcare providers to understand the factors affecting adherence in adolescents with IBD and to develop and implement intervention strategies to promote medication adherence.…”

“…The MAl designed by Mackner and Crandall (2005) is a semi-structured interview for assessing barriers to adherence in children with IBD. These factors include educational (knowledge of treatment and medications, etc.…”