Medication Adherence In Adolescents Research Articles

The feasibility of text reminders to improve medication adherence in adolescents with asthma.

Personal health applications have the potential to help patients with chronic disease by improving medication adherence, self-efficacy, and quality of life. The goal of this study was to assess the impact of MyMediHealth (MMH) - a website and a short messaging service (SMS)-based reminder system - on medication adherence and perceived self-efficacy in adolescents with asthma. We conducted a block-randomized controlled study in academic pediatric outpatient settings. There were 98 adolescents enrolled. Subjects who were randomized to use MMH were asked to create a medication schedule and receive SMS reminders at designated medication administration times for 3 weeks. Control subjects received action lists as a part of their usual care. Primary outcome measures included MMH usage patterns and self-reports of system usability, medication adherence, asthma control, self-efficacy, and quality of life. Eighty-nine subjects completed the study, of whom 46 were randomized to the intervention arm. Compared to controls, we found improvements in self-reported medication adherence (P = .011), quality of life (P = .037), and self-efficacy (P = .016). Subjects reported high satisfaction with MMH; however, the level of system usage varied widely, with lower use among African American patients. MMH was associated with improved medication adherence, perceived quality of life, and self-efficacy.Trial Registration This project was registered under http://clinicaltrials.gov/ identifier NCT01730235.

Subjective experience and medication adherence in adolescents with psychiatric disorders – preliminary findings from the Mannheim SEMA study

Subjective experience and medication adherence in adolescents with psychiatric disorders – preliminary findings from the Mannheim SEMA study

What can we learn from adherence data in adolescents participating in a clinical trial?

Treatment adherence during adolescence is challenging. Limited data exist for the rate of medication adherence in adolescents.

Longitudinal associations between asthma control, medication adherence, and quality of life among adolescents: results from a cross-lagged analysis.

It is not completely clear whether and how medication adherence, asthma control, and quality of life (QOL) predict each other over time. Therefore, the aim of the present study was to examine the longitudinal associations between asthma control, medication adherence, and quality of life among adolescents. In this 3-wave longitudinal study, adolescents (N = 139, Mean age = 11.8) completed questionnaires about their medication adherence (Medication Adherence Report Scale for Asthma), asthma control (Asthma Control Questionnaire), and QOL (Adolescent Asthma Quality of Life Questionnaire) during home visits in the spring/summer of 2011, 2012, and 2013. Cross-lagged analyses examined temporal interrelations between the three variables over the course of 3 years. Higher QOL at baseline predicted increased medication adherence at follow-up (T2), but did not predict changes in asthma control over time. Medication adherence and asthma control did not predict changes in QOL over time. There were no associations between asthma control and medication adherence over time. Interventions could focus on increasing QOL to increase medication adherence in adolescents with asthma.

Usefulness of FaceTime to Improve Medication Adherence in Adolescents and Young Adults with Systemic Lupus Erythematosus: A Case Series

Poor adherence to medications is a ubiquitous problem in patients with chronic diseases such as systemic lupus erythematosus (SLE), and can be associated with higher risk of disease flare and mortality. With the increasingly accessible use of mobile technology in health care, a novel application has emerged: the use of mobile technology to improve medication adherence in patients with chronic disease. We report the use of video-conferencing via FaceTime to improve medication adherence in childhood-onset SLE patients treated with mycophenolate mofetil. All of the patients had an undetectable mycophenolic acid (MPA) level prior to remote directly observed therapy (remote DOT) with FaceTime. The primary outcome was achievement of a therapeutic MPA level after remote DOT with FaceTime, and was met in all patients. This suggests an important role for video-conferencing in the improvement of medication adherence and disease outcomes not only in SLE patients, but in young adults with other chronic diseases.

Health Literacy and Medication Adherence in Adolescents

To assess the relationship between health literacy levels and medication adherence in adolescents. A convenience sample of adolescents ages 12-21 years was recruited April-September 2011 at an urban adolescent health center. Health literacy and medication adherence was measured via the Rapid Estimate of Adult Literacy in Medicine-TEEN (REALM-TEEN) and Adherence to Refills and Medications Scale. The interrelated effects of age, sex, chronic illness, learning disability, health rating, and health literacy on adherence to medication were explored via the use of regression trees. Of 138 adolescents surveyed, 112 (81%) were included in the analysis because they reported ever taking a medication and completed all survey questions. Median participant age was 16.1 years, 94% were African American, and 64% were female. Median REALM-TEEN score was 57 (6th-7th grade; range 0-66). Median ARMS score was 21 (poor; range 0-56). A positive correlation was found between worse adherence (greater ARMS scores) and self-report of a learning disability (P = .041), and between ARMS scores and having a chronic illness (P = .003). The ARMS and REALM-TEEN scores were not correlated (P = .069). Regression tree analysis indicated that adolescents with both a chronic illness and a learning disability had worse ARMS scores (median score 24), compared with adolescents having only a chronic illness (median score 22), independent of health literacy scores. Almost one-quarter of adolescents reported having a learning disability and had worse medication adherence independent of health literacy levels. This finding suggests other cognitive factors, beyond reading, may play a role in medication adherence.

Medication adherence in adolescents in current practice: community pharmacy staff's opinions.

To explore pharmacy staff's perspectives regarding medication use behaviour in adolescent patients. Structured face-to-face interviews were conducted with 170 community pharmacy staff members. Medication-related problems in adolescents had been experienced by 80 respondents; non-adherence was frequently mentioned (n = 73). An important reason for medication-related problems in adolescents not being recognised was that prescriptions are often collected by the parents (with or without the teenager). Solutions suggested by the interviewees to improve adolescents' medication use behaviour included (improving) counselling with emphasis on necessity/benefits of medication (n = 130) and more direct contact with adolescents instead of parent(s) (n = 77). Use of digital media for educational purposes or reminder services was suggested to support medication use (n = 67). Almost half of pharmacy staff experienced problems related to medication use in adolescents. Pharmacy staff see a primary role for counselling on the benefits of therapy but foresee difficulties in obtaining direct contact with adolescents. Use of new media could be useful.

Health Literacy Is Associated With Medication Adherence In Adolescents and Young Adults With HIV-1 Infection

Health Literacy Is Associated With Medication Adherence In Adolescents and Young Adults With HIV-1 Infection

P-173 Improving Oral Medication Adherence in Adolescents with IBD

P-173 Improving Oral Medication Adherence in Adolescents with IBD

Emotional Functioning, Barriers, and Medication Adherence in Pediatric Transplant Recipients

This study assessed relationships among internalizing symptoms, barriers to medication adherence, and medication adherence in adolescents with solid organ transplants. The sample included 72 adolescents who had received solid organ transplants. Multiple mediator models were tested via bootstrapping methods. Bivariate correlations revealed significant relationships between barriers and internalizing symptoms of depression, anxiety, and posttraumatic stress, as well as between internalizing symptoms and medication adherence. Barriers indicative of adaptation to the medication regimen (e.g., forgetting, lack of organization) were related to medication adherence and mediated the relationship between internalizing symptoms and medication adherence. These findings indicate that barriers may serve as a more specific factor in the relationship between more general, pervasive internalizing symptoms and medication adherence. Results may help guide areas for clinical assessment, and the focus of interventions for adolescent transplant recipients who are experiencing internalizing symptoms and/or who are nonadherent to their medication regimen.

Effect of Type D personality on medication adherence in early adolescents with asthma

ObjectiveMedication adherence for daily preventive asthma medication is especially low during adolescence. In the present study, we aimed to test whether Type D personality (both as a category and with its constituent components (negative affectivity: NA and social inhibition: SI) separately and in interaction) predicts medication adherence of early adolescents with asthma. MethodsIn a prospective study, 188 early adolescents with asthma who were prescribed daily preventive asthma medication completed questionnaires on Type D personality, medication adherence, socio-demographic and clinical information, and depressive symptoms in the Spring/Summer of 2011 (T1) and again 12months later (T2). Multiple regression analyses, controlling for demographic and clinical information and for depressive symptoms, were conducted to test whether Type D personality (either as a categorical or dimensional construct) predicted changes in medication adherence over time. ResultsAdherence was significantly lower at T2 than at T1 and this decrease was predicted by the categorical construct of Type D personality. Analyses of the two separate dimensions NA and SI and their interaction showed that higher scores on NA at T1 predicted more decrease in adherence over time. Neither SI nor the interaction between NA and SI predicted changes in adherence. ConclusionThis is the first study to test the relationship between Type D personality and medication adherence in adolescents. Although categorical Type D personality predicts mediation adherence of adolescent with asthma over time, dimensional analyses suggest that this is due to negative affectivity only, and not to the combination of negative affectivity and social inhibition.

Motivational Interviewing: A Tool for Increasing Psychotropic Medication Adherence for Youth

There are serious outcomes to nonadherence to psychotropic medications in children and adolescents, including poor school performance, prolonged duration of illness, increased psychopathology, poor interpersonal relationships, increased psychiatric episodes, and suicide attempts. Medication treatment has demonstrated improved psychiatric functioning and a 50% reduction in suicidal behavior. more than 50% of youth with mental health problems are nonadherent with psychiatric medications. A review of literature examining motivational interviewing (MI) for the problem of treatment adherence in children and adolescents is discussed. MI has great potential to improve psychiatric medication adherence in adolescents. An example of how to implement MI with youth is provided.

Disparities in antihypertensive medication adherence in adolescents

Hypertension affects up to 5 % of all children, but little is known about the role of medication adherence on blood pressure (BP) control. In this study we examined the association between adolescents' antihypertensive medication adherence and BP control, investigating for racial disparities. A total of 21 adolescents with essential hypertension [mean age 14.7 ± 2.0 years, 57 % male, 52 % African American] were recruited from a pediatric nephrology clinic. Objective medication adherence measures were obtained with Medication Event Monitoring System (MEMS) caps and pharmacy refill records to determine medication possession ratios (MPRs). The African Americans adolescents had lower medication adherence than non-African Americans adolescents based on the MPR over the past 12 months (mean 0.54 ± 0.21 vs. 0.85 ± 0.16, respectively; p < 0.001) and a trend for less adherence measured by MEMS caps over the last 28 days (mean 0.75 ± 0.26 vs. 0.91 ± 0.04, respectively; p < 0.07). Seven of the eight participants with low adherence (MPR <0.65) had uncontrolled BP (systolic and/or diastolic BPs ≥ 95th percentile), and no participants with high adherence according to the MPR had uncontrolled BP (p < 0.001). There was no difference in BP control by race. Antihypertensive medication adherence measured by pharmacy refills was associated with BP control. AAs were more likely to have lower medication adherence. Targeting medication adherence through the use of electronic medical records may be a potential mechanism to reduce health disparities.

Promoting Medication Adherence and Regimen Responsibility in Two Adolescents on Hemodialysis for End-Stage Renal Disease

Medication adherence and regimen responsibility (RR) have important implications for adolescents with hemodialysis-dependent end-stage renal disease (ESRD). This case study assesses the preliminary efficacy of a cognitive-behavioral intervention to promote medication adherence and RR in two African American adolescents. Two patients and their mothers participated. Intervention modules addressed adherence barriers. Using a case-series design, weekly parent–adolescent reports of medication adherence and RR were collected. The female participant’s selective nonadherence improved during treatment. Mother and daughter were high in RR throughout the study. The male participant’s adherence initially decreased following his mother’s reduced involvement in treatment. His adherence improved by the end of treatment, and coincided with his mother’s reassumption of RR. Improvements were maintained through follow-up for both patients. This case study provides preliminary support for using a cognitive-behavioral protocol to improve medication adherence in adolescents with hemodialysis-dependent ESRD.

147. Does Health Literacy Predict Medication Adherence in Adolescents? Exploring Teens and the Measures

American, 46.8% Latino; 70.9% haveMedicaid; 65.3% have household income $25,000. Adolescents made up 17.8% (n 127) of the CAI population. Adolescents showed similar positive outcomes to children at 12 months post-enrollment: reductions in hospitalizations (73.7% in adolescents vs. 80.8% in children; both p 0.001), ED visits (65.5% vs. 64%; both p 0.001), missed school days (40.6% vs. 41.4%; both p 0.001), and missed work days (48% vs. 45%; both p 0.001). These reductions were not statistically significantly different between the two age groups. The reduction in limitation of physical activity (45.8% vs. 27.6%; p 0.099 vs. p 0.003) was greater for children. The risk of limitation of physical activity was two times greater (OR 1.95; 95% CI 1.03 to 3.69) for children compared to adolescents at 12 months post-enrollment. GIS mapping showed the majority of patients live in the poorest neighborhoods of Boston, and the distance from the hospital was not significantly different for the two groups (2.46 miles 2.82 for adolescents, 2.21 miles 1.51 for children; p 0.16). The ROI was 1.46 (benefits/program cost) and the SROI is 1.73 including Quality of Life (QOL) measures. Conclusions: CAI reductions in hospitalizations, ED visits, and QOL indicators were similar for adolescents and children. GIS Mapping shows overlap with areas of greatest poverty and no significant differences for adolescents and children. This model of asthma care has generated information to develop policy advocacy efforts to improve services and financing of enhanced asthma care. Sources of Support: This program is supported in part by CDC REACH US #1U58DP001055-01, Healthy Tomorrows #H17MC06705 and #H17MC21564, and LEAH #T71M9, MCHB, and HRSA.

Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease

To pilot test the feasibility and acceptability of a family-based group behavioral intervention and to improve medication adherence in adolescents diagnosed with inflammatory bowel disease. Participants were 40 adolescents aged 11-18 years diagnosed with inflammatory bowel disease and their primary caregivers, who were randomized to either a four-session Family-Based Group Behavioral Treatment or Usual Care over a 6-week period. Adherence was measured using a multi-method, multi-informant assessment involving caregiver-report and patient-report, pill count data, and electronic monitoring. Adherence rates ranged from 66 to 89% for 6-mercaptopurine/azathioprine and 51 to 93% for mesalamine across assessment methods. The intervention was feasible, as evidenced by the 99% treatment session attendance rate, and acceptable based on patient and caregiver report. Repeated measures analysis of variance tests revealed nonsignificant differences between the conditions from baseline to post-treatment assessments for pill count, electronic monitor, and primary caregiver-reported adherence (P's>0.05). There was a statistically significant improvement in patient-reported mesalamine adherence represented by a significant main effect for Condition (F=22.24, P<0.01; δ=0.79) and Condition×Time interaction (F=13.32, P<0.05; δ=0.69). Findings suggest potential for use of behavioral intervention to improve medication adherence in this population. This intervention may be more effective with more complex regimens (e.g. multiple doses per day) such as those prescribed with mesalamine. Further research is needed to examine this type of intervention in more diverse samples with more active disease. Use of alternative adherence measurement approaches, including electronic pill boxes and/or real-time self-report (e.g. by text messaging, electronic diaries, etc.) is also recommended.

Barriers to medication adherence in adolescents within a school environment

AimsThe aim of this study was to identify perceived barriers to medication adherence in early adolescents within a school environment. By way of background, 20% of adolescents have a chronic...

Predicting Medication Adherence in Adolescents With Pelvic Inflammatory Disease (PID)

Previous studies have examined medication adherence in adult patients diagnosed with PID, however, there is limited knowledge on adolescent adherence to medications. The aim of this study was to explore potential predictors of adherence to medications in an urban population of adolescents diagnosed with PID in an effort to better define risk profiles for disposition.

543 A Systematic Review of Interventions to Improve Adherence to Medicines in Adolescent Patients

Background and aims: Although adolescents have been identified as the most non-adherent patient group, the effectiveness of efforts employed to combat non-adherence to medicines, the key contributor to treatment failure, have not been systematically assessed. Extrapolating results from previous reviews spanning various patient ages is difficult due to this groups distinct developmental challenges. This review was undertaken to explore the effectiveness of adherence enhancing interventions (AEIs) aimed at improving medication adherence in adolescents on long term treatment. Methods: Seven databases were searched to identify concurrent controlled and RCTs of AEIs studies published between 1984-2009, specifically targeted at adolescents. Data extracted were analysed and presented qualitatively. Results: Twenty studies were identified from the original 22,784 citations. Fifteen were US based and eleven targeted diabetic patients. Consideration of the developmental stages differentiating groups of adolescents was not always evident. Interventions employed were complex and utilised various adherence definitions and measures. Methods to improve adherence included increasing the acceptability of the drug formulation; improving access to care; engaging the support of family and system at large; and by empowering patients through teaching problem-solving skills. The effects of the interventions were mixed with a few studies failing to improve treatment adherence or health care outcome. Conclusions: To some extent interventions to improve medicine adherence in adolescents have achieved their purpose. However owing to the dissimilarity of interventions no one intervention can be considered superior. Future attempts to improve adherence to medicines need to be developed against the backdrop of the developmental pressures facing adolescents.

Medication Adherence in Adolescents With Behaviorally-acquired HIV: Evidence for Using a Multimethod Assessment Protocol

The present study investigated medication adherence in an understudied population, adolescents with behaviorally acquired HIV, to improve upon prior methodological limitations using concurrent collection of HIV health status markers (viral load [VL]; percentage CD4 count [CD4%]) and multimethod adherence assessment (pill count, missed doses, off-schedule dosing). A total of 60 youth with behaviorally acquired HIV receiving routine care in a multidisciplinary specialty clinic in the Mid-Southern United States. Adherence was assessed by routine pharmacy pill count and self-reported 3-day recall of doses missed and doses taken off-schedule, collected concurrently with clinically obtained VL and CD4% indicators. Adherence measures were evaluated as predictors of VL and CD4% using logistic regression analyses. Adherence difficulties were detected by all assessment methods, with off-schedule dosing appearing the most problematic (29.4% taken off-schedule). Self-report of doses missed (p = .038) and off-schedule dosing (p = .021) significantly predicted detectable VL. For each percent increase in nonadherence by off-schedule dosing, there was a 2% increased likelihood of detectable VL. No adherence measure significantly correlated with CD4%; pharmacy pill count did not relate to either health status marker. This study is the first to document multimethod medication adherence measurement in a defined sample of adolescents with behaviorally acquired HIV, using imposed concurrent collection of CD4% and VL. Adherence difficulties were detected regardless of assessment strategy, with off-schedule dosing representing the greatest nonadherence behavior. Both 3-day recall methods predicted VL. Further investigation of adherence in larger samples of youth with behaviorally acquired HIV is needed to better understand the relationship to CD4% suppression.