The Stability and Influence of Barriers to Medication Adherence on Seizure Outcomes and Adherence in Children With Epilepsy Over 2 Years

Ramsey, Rachelle R.; Zhang, Nanhua; Modi, Avani C.

doi:10.1093/jpepsy/jsx090

Cited by 30 publications

(19 citation statements)

References 37 publications

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“…However, to our knowledge, this is the first study to systematically assess barriers to adherence in this patient population. Our results are consistent with previous studies exploring barriers to adherence in children and parents of children with chronic medical conditions including asthma, cystic fibrosis, sickle cell disease, and epilepsy 32,47‐49 . These studies demonstrated high prevalence of individual barriers and the majority of parents and patients report more than one barrier to adherence.…”

Section: Discussionsupporting

confidence: 92%

Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia

Heneghan

Hussain

Barrera

et al. 2020

Pediatric Blood & Cancer

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Background Adherence to oral chemotherapy, including 6‐mercaptopurine (6‐MP), is suboptimal in pediatric acute lymphoblastic leukemia (ALL), which is associated with increased risk of relapse. Study objectives were to examine self‐reported adherence to 6‐MP and related barriers to adherence, mapped to the capability, opportunity, motivation, and behavior (COM‐B) model for behavior change. Procedure Forty‐nine parents (median, 39 years old; 76% females) and 15 patients (median, 17 years old, 20% females) completed the study survey. Results Suboptimal adherence was reported in 43% of parents and 73% of patients. Most parents and patients (80% and 90%, respectively) reported ≥1 adherence barrier. Parents reported difficulty helping their child meet others with ALL (43%), contacting community organizations (39%), and meeting other parents (37%). Patients reported difficulty finding out what their medications are (40%), finding out what 6‐MP does (47%), and meeting other patients (40%). Using the COM‐B, we found that parents and patients endorsed barriers in multiple components, especially physical (55%, 67%) and social opportunity (56%, 47%), highlighting that barriers to adherence may be multifaceted. Conclusions Our results suggest that parents and patients with ALL face various prevalent barriers to medication adherence and provide insight into the development of behavioral interventions focused on promoting adherence, which is essential to prevent relapse and optimize health outcomes in ALL.

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Section: Discussionsupporting

confidence: 92%

Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia

Heneghan

Hussain

Barrera

et al. 2020

Pediatric Blood & Cancer

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“…For the control group, objective adherence continued to decline over the duration of the study indicating that poor adherence to medication may not improve without intervention. A similar trend has been reported for those with poor medication adherence, without targeted intervention, in other chronic conditions [12,26,27].…”

Section: Discussionsupporting

confidence: 79%

“…In addition, real or perceived side effects, low medication literacy, and/or poor medication taste were identified as adherence barriers in cSLE. Unfortunately, adherence barriers are stable and unlikely to improve without interventions [12,13].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of an innovative adherence intervention for young adults with childhood-onset systemic Lupus Erythematosus

et al. 2020

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Background: In Childhood-Onset Systemic Lupus Erythematosus (cSLE), poor medication adherence rates are very high. Interventions targeting this problem in cSLE are limited thus effective interventions are needed. The objective of this study is to examine the feasibility and acceptability an intervention (automated digital reminders + personalized prescribed treatment plan (pPTP)) to improve medication adherence in young adults with cSLE over 3 months. Method: This is a proof-of-concept randomized controlled study. All participants received SimpleMed+ pillboxes that track adherence. The treatment group received a pPTP, and in month 2, preselected digital reminders for missed doses. Reminders were discontinued after 30 days and adherence data collected. Data analysis was done using t-tests. Results: Twenty-one participants were approached and nineteen consented to participate, yielding a recruitment rate of 86%. Participants were on average 20.5 years, mostly black (58%) and female (84%). Of the nineteen consented, eleven were randomized to control (57%) and eight to treatment (42%) groups respectively. All participants in the treatment group rated the pillbox as easy to use, notably; none reported boredom with the pillbox or reminders. Also, 88% of participants in the treatment group rated the pillbox as helpful, however, only 50% reported the pPTP taught them new information about lupus or made them more interested in their lupus management. Conclusions: This is the first use of an electronic pillbox to track adherence to multiple medications in cSLE. The high rating of the pillbox makes it an acceptable method of measuring adherence. Feasibility and acceptability ratings for the intervention were mixed suggesting a there is a subset of cSLE patients for whom this intervention would be beneficial. Future research should focus on a larger trial.

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“…Barriers to adherence are modifiable variables that demonstrate consistent associations with nonadherence and suboptimal clinical outcomes in pediatric populations [9, 10]. Among children with epilepsy, barriers such as difficulties swallowing medications, forgetfulness and refusing to take medications as prescribed have been longitudinally associated with electronically-monitored nonadherence [11]. The stability of barriers to adherence has also been documented in children with newly diagnosed epilepsy, suggesting that once a barrier is endorsed, it is likely to persist for a 2-year period without targeted intervention.…”

Section: Introductionmentioning

confidence: 99%

Adherence barriers in pediatric epilepsy: From toddlers to young adults

Gutierrez‐Colina

Smith

Mara

et al. 2018

Epilepsy & Behavior

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The Stability and Influence of Barriers to Medication Adherence on Seizure Outcomes and Adherence in Children With Epilepsy Over 2 Years

Abstract: Assessing for specific adherence barriers over time may lead to identification of interventions that result in improved adherence and care.

Cited by 30 publications

References 37 publications

Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia

Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia

Feasibility and acceptability of an innovative adherence intervention for young adults with childhood-onset systemic Lupus Erythematosus

Adherence barriers in pediatric epilepsy: From toddlers to young adults

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