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      Practice survey: adherence monitoring and intervention in pediatric gastroenterology and hepatology

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          Abstract

          Purpose

          Despite significant medication nonadherence rates among youth with pediatric gastroenterology and hepatology disorders, little is known about current adherence practices in pediatric gastroenterology care. This study summarizes current practices surrounding adherence monitoring and intervention in pediatric gastrointestinal (GI) and hepatologic care in the USA.

          Participants and methods

          One hundred and fifty-four pediatric GI providers completed an online survey designed to examine current practices surrounding adherence monitoring and intervention, specific strategies used to monitor and treat poor adherence, and the barriers currently experienced in relation to adherence monitoring and intervention.

          Results

          Practices varied greatly in terms of when and how patient adherence is monitored and by whom; however, physicians and nursing professionals take primary responsibility for adherence monitoring. Approximately 25% utilize screeners to assess adherence, and most participants use patient and caregiver reports as a primary measure of adherence. Most participants rated their level of adherence monitoring and intervention as fair to poor. While most participants perceive adherence monitoring to be very important in clinical practice, only 20.8% perceive being able to significantly modify patient adherence.

          Conclusion

          There exists great variability in adherence monitoring and intervention practices across pediatric GI providers. Greater understanding of current adherence practices can inform future clinical efforts.

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          Most cited references 22

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          Adherence to medication

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            What are validated self-report adherence scales really measuring?: a systematic review.

            Medication non-adherence is a significant health problem. There are numerous methods for measuring adherence, but no single method performs well on all criteria. The purpose of this systematic review is to (i) identify self-report medication adherence scales that have been correlated with comparison measures of medication-taking behaviour, (ii) assess how these scales measure adherence and (iii) explore how these adherence scales have been validated.
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              Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions.

              To estimate the effectiveness of adherence-promoting psychological interventions for pediatric populations with chronic health conditions. A meta-analysis was conducted on 70 adherence-promoting psychological intervention studies among chronically ill youth using a weighted least squares approach and random effect model. Medium effects sizes were found for the behavioral (mean d =.54, 95% confidence interval [CI] = 0.34-0.73, n = 10) and multi-component interventions (mean d =.51, 95% CI = 0.45-0.57, n = 46), while educational interventions displayed a small effect size with adherence (mean d =.16, 95% CI = 0.10-0.22, n = 23). Study designs incorporating pre-post comparisons yielded effect sizes approaching the medium range (mean d =.42, 95% CI = 0.36-0.48, n = 30). Behavioral and multi-component interventions appear to be relatively potent in promoting adherence among chronically ill youth. Recommendations for future research and methodological issues are presented.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                11 July 2018
                : 14
                : 1227-1234
                Affiliations
                [1 ]Division of Developmental and Behavioral Sciences, Children’s Mercy-Kansas City, Kansas City, MO, USA, mhmaddux@ 123456cmh.edu
                [2 ]Division of Gastroenterology, Children’s Mercy-Kansas City, Kansas City, MO, USA, mhmaddux@ 123456cmh.edu
                Author notes
                Correspondence: Michele H Maddux, Division of Developmental and Behavioral Sciences, Division of Gastroenterology, Children’s Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64109, USA, Tel +1 816 234 3862, Fax +1 816 302 9898, Email mhmaddux@ 123456cmh.edu
                Article
                tcrm-14-1227
                10.2147/TCRM.S159611
                6047608
                © 2018 Maddux et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                compliance, adherence, intervention, clinical practice, screening

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