Adherence to Pediatric Medical Regimens

Description:

The third edition of this book provides comprehensive coverage of pediatric medical adherence, including such important topics as the extent of nonadherence and medical consequences, predictors of adherence, theories about adherence and clinical applications, and assessment strategies for adherence and health outcomes. In addition, chapters describe strategies for improving adherence, review research studies on improving adherence, and address ways to improve research on adherence for children and adolescents with chronic diseases. The new edition also examines the developmental aspects of adherence assessment and intervention as well as cultural, ethical, and legal issues in adherence research and practice.

Key areas of coverage include:

• Consequences of nonadherence and correlates of adherence.
• Developmental aspects related to assessing and improving pediatric medical adherence.
• Assessing pediatric disease and health status.
• Cultural, ethical, and legal issues related to pediatric medical adherence.

Adherence to Pediatric Medical Regimens, Third Edition, is an essential reference for researchers, professors, and graduate students as well as clinicians, therapists, and other practitioners in developmental, clinical child and school psychology, child and adolescent psychiatry, pediatrics and pediatric psychology, social work, public health, health psychology, and all interrelated fields.

See more medical ebooks at here:

A Practical Guide on Behaviour Change Support for Self-Managing Chronic Disease

Dietary Inflammatory Index, Alternative Healthy Eating Index-2010, Mediterranean Diet Score and the risk of pancreatic cancer

Pediatric Chronic Kidney Disease

Association between metabolic syndrome and participation in colorectal cancer screening in Japan: A retrospective cohort analysis using LIFE study data

Worldwide Successful Pediatric Nurse-Led Models of Care

Preface

Medications don’t always work like they should, transplanted organs are rejected, bacteria develop resistance to previously effective antibiotics, and physicians are hampered in their ability to judge the efficacy of treatments they have prescribed. What factors could account for these alarming trends in medicine? One significant factor is that patients and their families don’t always adhere to prescribed treatments. Why this is the case and what can be done about it is the subject of this book.

Before proceeding with the discussion of medical adherence in pediatrics, several caveats are in order:

1. It is incumbent on medical providers that they are asking patients to adhere to regimens with demonstrated efficacy. Providers need to remind themselves of the Hippocratic Oath: “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous” (as cited in Cassell, 1991, p. 145).

Providers need to be adherent to established treatment guidelines. For example, interventions have been tested that targeted improvements in adherence to asthma treatment guidelines by providers (Okelo et al., 2013)

2. Providers need to abandon the “blame and shame” approach to dealing with medical adherence problems. It is tempting to blame patients for adherence failures and shame them into changing their behavior. Providers need to share the blame (or better yet omit blame) and look at their own attitudes and behaviors which impact adherence. For example, failing to simplify regimens or minimize negative side-effects can adversely impact patient adherence.

3. Patients and their families are no longer (or maybe were never) satisfied with a passive role in their health care. In fact, the term “compliance” lost favor in the literature because it implied for some an authoritarian approach to health care that required unquestioned obedience by patients to provider recommendations (Dimatteo & DiNicola, 1982; Vrijens et al., 2012). Comprehensive and effective health care requires a cooperative relationship between providers and patients and their families. It also acknowledges the following realities, particularly for treating persons with chronic illness:

Doctors do not treat chronic illnesses. The chronically ill treat themselves with the help of their physicians; the physician is part of the treatment. Patients oversee themselves. They determine their food, activity, medications, visits to their doctors – most of the details of their own treatment. (Cassell, 1991, p. 124)

4. Finally, children are not little adults. Pediatric adherence issues are arguably more complex than with adults because of the influences of family members and peers. There are also developmental processes and constraints that uniquely affect adherence for children and adolescents. Caution is in order when extrapolating from theoretical and empirical work with adults and applying this information to pediatric patients.

This volume is intended to give primary and allied healthcare providers, researchers, and students an overview of the topic of medical adherence in pediatrics. Chapter 1 reviews definitions of adherence, types of adherence problems, and adherence rates to regimens for chronic diseases. Chapter 2 is a review of the consequences of nonadherence and correlates of adherence. Chapter 3 reviews and critiques adherence theories, such as self-efficacy theory, and the clinical implications of these theories. Chapter 4 reviews developmental factors related to assessing and improving adherence (a new chapter for this edition). Chapter 5 describes and critiques different measures of adherence such as assays, electronic monitoring, and self-reports. Chapter 6 reviews measures of disease and health status measures, such as quality of life (this chapter has been separated from the chapter on adherence measures from the previous edition, as this is a growing topic and deserves a chapter of its own). Chapter 7 summarizes and critiques adherence intervention studies for chronic pediatric diseases including meta-analyses of pediatric adherence intervention studies. Chapter 8 is a review of educational, organizational, and behavioral strategies for improving adherence. Chapter 9 review ways to improve pediatric medical adherence research, such as using single-subject designs, minimizing attrition, and calculating effect sizes and documenting clinical significance/social validity (a new chapter for this edition). Chapter 10 concludes the book with a review of cultural, ethical, and legal issues related to adherence clinical and research activities (also a new chapter for this edition).

Kansas City, KS, USA Morgantown, WV, USA Michael A. RapoffChristina DuncanJackson, MS, USA Cynthia Karlson

Table of contents :
Preface
Contents
Chapter 1: Definitions of Adherence, Types of Adherence Problems, and Adherence Rates
The Problem of Adherence
Definitions
Types of Adherence Problems
Adherence Rates to Chronic Disease Regimens
References
Supplemental Reference List for Table 1.1
Chapter 2: Consequences of Nonadherence and Correlates of Adherence
Consequences of Nonadherence
Health and Medical Outcomes
Quality of Life
Cost-Effectiveness of Medical Care
Clinical Decisions
Clinical Trials
Correlates of Adherence to Medical Regimens
Patient/Family Correlates
Demographics
Knowledge
Patient Adjustment and Coping
Family Adjustment and Coping
Parental Involvement/Monitoring
Reported Barriers
Disease-Related Correlates
Duration
Course
Symptoms/Disease Severity
Perceived Severity
Regimen-Related Correlates
Type and Complexity
Costs
Side Effects
Efficacy
Clinical Implications Related to Adherence Correlates
References
Chapter 3: Adherence Theories: Review, Critique, and Clinical Implications
Importance of Theories in Clinical and Research Activities
The Health Belief Model
Description
Critical Appraisal
Clinical Implications of the HBM
Social Cognitive Theory (Self-Efficacy)
Description
Critical Appraisal
Clinical Implications of SCT (Self-Efficacy)
The Theory of Reasoned Action/Planned Behavior
Description
Critical Appraisal
Clinical Implications of the TRA/PB
Transtheoretical Model
Description
Critical Appraisal
Clinical Implications of the TTM
Applied Behavior Analytic Theory
Description
Critical Appraisal
Clinical Implications of ABA Theory
Summary and Implications of Adherence Theories
References
Chapter 4: Developmental Considerations in Assessing and Improving Adherence
Developmental Stages
Youth Cognitive Factors Related to Adherence
Perception of Their Health Condition
Understanding Medical Information
Appreciating Consequences Associated with Care
Recognizing and Reporting Symptoms
Reporting Accurately on Adherence Behaviors
Making Medical Decisions and Ability to Self-Regulate
Implications for Assessment of Adherence and Related Factors
Developmental Trends for Adherence Rates
Emotional and Psychological Factors
Peer Influence Factors
Family Functioning Factors
Implications for Designing Adherence-Promotion Interventions
Optimizing Provider Communication
Obtaining Partnership with Youth for Shared Decision-Making
Encouraging Parental Supervision and Involvement
Paternal Involvement
Parent-Child Agreement Regarding Responsibility
Addressing the Transfer of Responsibility from Parents to Youth
Promoting Transition Readiness
Engaging Youth as Key Stakeholders in Intervention Development
References
Chapter 5: Assessing Adherence and Methodological Considerations
Why Assess Adherence?
Screening and Diagnosis
Prediction
Intervention Selection
Evaluation of Intervention Efforts
What to Assess?
Guidelines for Selecting Target Regimen Behaviors
Who Should Be Assessed and Who Should Assess?
How to Assess Adherence?
Therapeutic Drug Monitoring
Description
Advantages
Disadvantages
Electronic Monitors
Description
Advantages
Disadvantages
Pharmacy Refill Measures
Description
Advantages
Disadvantages
Pill Counts
Description
Advantages
Disadvantages
Observation
Description
Advantages
Disadvantages
Provider Estimates
Description
Advantages
Disadvantages
Patient and Caregiver Reports
Description
Advantages
Disadvantages
Comparative Performance of Adherence Measures
Methodological Issues and Recommendations for Adherence Measurement
Reactivity
Representativeness
Directness
Measurement Standards
Interpretation or What’s in a Number?
Clinical and Treatment Utility
Summary
References
Untitled
Chapter 6: Assessing Disease and Health Outcomes
Disease and Health Status Measures
Patient-Level Outcomes
Micro-level Outcomes
Meso-level Outcomes
Macro-level Outcomes
Methodological Issues and Recommendations for Assessing Disease and Health Measures
Choice of Informants
Representativeness
Generic Versus Disease-Specific Measures
Psychometric Standards
Limiting “Physiogenic Bias”
Clinical Feasibility, Utility, and Relevance
Clinical Implications of the Adherence-Outcome Relationship
Conclusions
References
Chapter 7: Review of Adherence Intervention Studies
Intervention Studies on Improving Adherence to Regimens for Chronic Pediatric Diseases
Meta-Analytic Reviews of Adherence Interventions for Pediatric Medical Regimens
Measuring Effectiveness
Meta-Analyses of Adherence Interventions for Chronic Pediatric Diseases
Asthma
Diabetes
HIV/AIDS
Organ Transplant
Mixed Chronic Disease
Conclusions from the Meta-Analyses
Conclusions and Literature Limitations
References
Chapter 8: Strategies for Improving Adherence to Pediatric Medical Regimens
Educational Strategies for Improving Adherence
The “Why?” or Goals of Education
The “What?” or Specific Objectives and Content of Education
What Is the Diagnosis and Related Information?
What Needs to Be Done to Control the Disease?
What Are the Potential Negative Side Effects of Treatment?
What Are the Benefits of and Strategies for Enhancing Adherence?
The “How?” of Educational Strategies
Education as an Ongoing Process
Effective Verbal Communication
Written Communication and Other Media
Modeling and Behavioral Rehearsal
Summary of Educational Strategies
Organizational Strategies for Improving Adherence
Increasing Accessibility to Healthcare
Consumer-Friendly Clinical Settings
Increasing Provider Supervision
Simplifying and Minimizing Negative Side Effects of Regimens
Using Motivational Interviewing to Enhance Provider/Patient and Family Communication and Relationships
Summary of Organizational Strategies
Behavioral Strategies for Improving Adherence
Parental Monitoring and Supervision
Prompting Adherence
Adherence Incentives
Discipline Strategies
Self-Management Strategies
Acceptance and Commitment Therapy (ACT)
Psychotherapeutic Interventions
Summary of Behavioral Strategies
Individualizing Interventions: Barriers to Adherence and Functional Analysis
Barriers to Adherence
Functional Analysis
Technology-Based Interventions
Conclusions
References
Chapter 9: Ways to Advance Pediatric Medical Adherence Research
Settle on a Standard Definition of Adherence
Develop Standard Scores Derived from Adherence Measures and Determine Cutpoints for Classifying People into Adherent and Nonadherent Categories
Revise, Rework, and Make Adherence Theories Relevant to Pediatrics
Develop Reliable, Valid, Sensitive, and Practical Self-report Measures of Adherence
Continue to Develop Electronic Monitor Measures of Adherence, and Extend Them to Regimen Components Other than Medications
Develop and Standardize Practical Measures of Disease Activity and Quality of Life
Validate Primary and Secondary Interventions to Prevent or Minimize Anticipated Declines in Adherence over Time
Make Better Use of Single-Subject Design Methodology for Intervention Studies
Develop and Test Innovative Adherence Promotion Strategies and Innovative Ways to Deliver the Interventions
Conduct Multi-site, Randomized Controlled Adherence Intervention Trials
Calculate Effect Sizes in Our Intervention Studies, and Document the Clinical Significance/Social Validity of Our Research
Define, Document, and Minimize Attrition in Research Studies
References
Chapter 10: Cultural, Ethical, and Legal Issues Involved in Adherence Clinical and Research Activities
Cultural Issues
Definitions of Culture
Why Is Culture Important?
Cultural Factors in Clinical Activities
Cultural Issues in Research Activities
Conclusion
Ethical Issues
Clinician-Patient Relationship
Researcher-Study Participant Relationship
Government-Citizenry Relationship
Payer-Client Relationship
Conclusion
Legal Issues
Medical Neglect
Religious Objections to Medical Care
Conclusion
References
Conclusion: The Inflated Importance of Adherence
References
Index