Article

Brief report: Barriers to treatment adherence in pediatric inflammatory bowel disease.

Cincinnati Children's Hospital Medical Center, Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH 45229-3039, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 12/2009; 35(9):1005-10. DOI: 10.1093/jpepsy/jsp126
Source: PubMed

ABSTRACT To examine perceived barriers to medication adherence in inflammatory bowel disease (IBD) treatment and their relationship with adherence using a combined forced choice and semi-structured interview assessment approach.
Sixteen adolescents with IBD and their parents participated in an open-ended interview regarding adherence barriers and completed quantitative measures of adherence, barriers to treatment, and disease severity.
The most commonly identified barriers to adherence were forgetting, interference with other activities, difficulty swallowing pills, and not being at home. Number of reported barriers was positively correlated with objective nonadherence for 6-MP/azathioprine. Nonadherence frequency was 42% for 6-MP/azathoprine and 50% for 5-ASA medications.
Using a combined assessment approach, patients and parents reported several barriers to treatment adherence that are appropriate for clinical intervention. This is critical given the significant medication nonadherence observed in this sample and the relationship between total number of barriers and disease management problems.

Download full-text

Full-text

Available from: Kevin Hommel, Mar 12, 2014
0 Followers
 · 
89 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Almost 80% of adult gastroenterologists report inadequacies in the preparation of patients transferred from pediatrics. To improve transition to adult care, it is important to identify the specific deficits that patients are demonstrating before transfer. We present data from a clinic-wide assessment of transition readiness skill acquisition in adolescents/young adults with IBD. A total of 195 patients (age, 16-25 yr) with IBD completed the Transition Readiness Assessment Questionnaire. Patient age, diagnosis, time since diagnosis, physician global assessment, and patient and parent disease management confidence ratings were extracted from the medical record. Transition Readiness Assessment Questionnaire scores were compared with a benchmark established by an interdisciplinary, multi-institutional Transition Task Force. Only 5.6% of older adolescents/young adults on the verge of transfer to adult care met our institutional benchmark (3.5% of adolescents, 7.3% of young adults). Patients reported mastery of 9.10 ± 4.68 out of 20 Transition Readiness Assessment Questionnaire items. Transition readiness was associated with older age (r = 0.27, P < 0.001) and female gender (F(1,192) = 13.81, P < 0.001) but not time since diagnosis, physician global assessment, or confidence ratings. Deficits in health care utilization/self-advocacy (e.g., understanding insurance, scheduling appointments/following up on referrals), and self-management (e.g., filling/reordering prescriptions) were observed. Most patients on the verge of transferring to adult care are not demonstrating transition readiness. Deficits observed represent modifiable behaviors. Using data-driven assessments to guide interventions to enhance transition readiness may minimize the retention of young adult patients in pediatrics and result in patients who are better prepared for adult care.
    Inflammatory Bowel Diseases 03/2015; 21(5). DOI:10.1097/MIB.0000000000000352 · 5.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Almost 80% of adult gastroenterologists report inadequacies in the preparation of patients transferred from pediatrics. Poorly managed transition results in treatment non-adherence, increased disease severity, and undue stress for patients, families, and health care providers. In order to prevent these outcomes and improve transition to adult care in IBD, it is important to identify the specific deficits in IBD management that pediatric patients are demonstrating prior to their transfer to adult care. The current study examines transition readiness skill acquisition in adolescents and young adults on the verge of transfer to adult care and identifies specific gaps in transition readiness that should be addressed prior to transfer.METHODS: Older adolescents and young adults (ages 16-25) in pediatric gastroenterology clinics in the Midwestern United States completed the Transition Readiness Assessment Questionnaire, Version 5 (TRAQ) as part of their routine medical care. This 20-item measure examines the mastery of skills essential to successful transition to adult care among youth with special healthcare needs. Based on prior work by an interdisciplinary, multi-institutional Transition Task Force, 90% mastery of TRAQ skills was considered a benchmark of transition readiness.RESULTS: 145 adolescents/young adults (M = 18.08 +/- 1.86 years; 56.6% male) completed the TRAQ. Data suggest that only 8 out of 145 patients (5.5%) on the verge of transfer to adult care are meeting institutional benchmarks for transition readiness (i.e., 90% mastery of readiness skills). On average, patients report mastery of 9 out of 20 skills (M = 9.08 +/- 4.83). Although a higher percentage of patients who are aged 18 years and over (N = 83) are meeting institutional benchmarks (7.2%), most adolescents and young adults demonstrate significant gaps in their transition readiness. Specific deficits were noted in the areas of self-management (e.g., obtaining and refilling prescriptions, proactive communication with providers) and self-advocacy/health care utilization (e.g., arranging and following up on needed IBD care, knowledge of health insurance coverage).CONCLUSIONS: Most patients on the verge of transferring to adult care are not meeting established benchmarks of transition readiness, indicating a critical need for additional intervention and support. The significant and specific deficits in transition readiness skills observed are all modifiable behaviors that can be targeted as part of a comprehensive IBD care program. Using objective benchmarks to routinely assess readiness skills may be an opportunity to quickly identify and address these deficits and enhance transition readiness. Addressing these deficits in pediatric care may minimize the retention of young adult patients in this setting and enhance the ability of adult gastroenterologists to provide the best possible care for their newly transferred patients.(C) Crohn's & Colitis Foundation of America, Inc.
    Inflammatory Bowel Diseases 01/2013; 19:S6. DOI:10.1097/01.MIB.0000438559.95140.eb · 5.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background:To examine the validity of patient self-report of thiopurine adherence in pediatric inflammatory bowel disease (IBD) against an objective electronic monitoring adherence measure, and to investigate the role of youth and maternal involvement in remembering to take daily medications as predictors of medication adherence.Methods:Fifty-one youths with IBD, ages 11–18 years, participated. Youths completed questionnaire assessments of their own and their maternal caregiver's involvement in remembering to take daily medications at baseline, completed monthly interviews assessing thiopurine adherence over the past week for a period of 6 months, and utilized a Medication Events Monitoring System (MEMS) electronic monitor for their thiopurine medication for 6 months. Participants were grouped into adherent (at least 80% of doses taken based on objective MEMS caps) or nonadherent for analyses.Results:Youths who were nonadherent based on electronic monitoring overestimated their adherence by 23%, whereas adherent youths overestimated their adherence by only 2%, and as such patient self-report offered little utility in identifying youths who were nonadherent. Youths who reported high levels of involvement in remembering to take their medications were nearly eight times less likely to be nonadherent.Conclusions:The current findings provide evidence that clinicians who work with children and adolescents with IBD may benefit from modifying their approach to nonadherence screening. Asking about youth involvement in remembering daily medications may be more informative than asking them to recall their medication-taking behavior over the last week in identifying those at highest risk for nonadherence. (Inflamm Bowel Dis 2011;)
    Inflammatory Bowel Diseases 08/2011; 18(7):1254 - 1259. · 5.48 Impact Factor