Yelena P Wu1, Ahna L H Pai2. 1. Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah; and yelena.wu@utah.edu. 2. Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Abstract
BACKGROUND AND OBJECTIVE: Improving medical regimen adherence is essential for maximizing the therapeutic potential of treatments for pediatric chronic illness. Health care providers are uniquely positioned to deliver adherence promotion interventions. However, no studies have summarized the effectiveness of health care provider-delivered adherence interventions. The objective of this study was to describe the effectiveness of health care provider-delivered adherence promotion interventions in improving adherence among children who have chronic illness. Data sources include PubMed, PsycINFO, CINAHL, and Scopus. Studies were included if they were randomized-controlled trials of pediatric interventions aiming to increase adherence to the primary regimen for a chronic illness and at least 1 health care provider delivered the intervention. RESULTS: A total of 35 randomized-controlled studies including 4616 children were included. Greater improvements in adherence were observed immediately after health care provider-delivered interventions (d = 0.49; 95% confidence interval, 0.32 to 0.66) than at longer-term follow-up (d = 0.32; 95% confidence interval, 0.10 to 0.54). Treatment effect sizes differed across the adherence behaviors measured. There was significant heterogeneity in treatment effects; however, no moderators of treatment effectiveness were identified. This meta-analysis focused on the published literature. In addition, the majority of studies involved children who had asthma and younger children. CONCLUSIONS: Health care provider-delivered interventions for children who have chronic illness can be effective in improving adherence. Gains in adherence are highest immediately after intervention. Future interventions and studies should include multiple methods of assessing adherence, include active comparators, and address long-term maintenance of adherence gains.
BACKGROUND AND OBJECTIVE: Improving medical regimen adherence is essential for maximizing the therapeutic potential of treatments for pediatric chronic illness. Health care providers are uniquely positioned to deliver adherence promotion interventions. However, no studies have summarized the effectiveness of health care provider-delivered adherence interventions. The objective of this study was to describe the effectiveness of health care provider-delivered adherence promotion interventions in improving adherence among children who have chronic illness. Data sources include PubMed, PsycINFO, CINAHL, and Scopus. Studies were included if they were randomized-controlled trials of pediatric interventions aiming to increase adherence to the primary regimen for a chronic illness and at least 1 health care provider delivered the intervention. RESULTS: A total of 35 randomized-controlled studies including 4616 children were included. Greater improvements in adherence were observed immediately after health care provider-delivered interventions (d = 0.49; 95% confidence interval, 0.32 to 0.66) than at longer-term follow-up (d = 0.32; 95% confidence interval, 0.10 to 0.54). Treatment effect sizes differed across the adherence behaviors measured. There was significant heterogeneity in treatment effects; however, no moderators of treatment effectiveness were identified. This meta-analysis focused on the published literature. In addition, the majority of studies involved children who had asthma and younger children. CONCLUSIONS: Health care provider-delivered interventions for children who have chronic illness can be effective in improving adherence. Gains in adherence are highest immediately after intervention. Future interventions and studies should include multiple methods of assessing adherence, include active comparators, and address long-term maintenance of adherence gains.
Authors: Lisa M Ingerski; Avani C Modi; Korey K Hood; Ahna L Pai; Meg Zeller; Carrie Piazza-Waggoner; Kimberly A Driscoll; Marc E Rothenberg; James Franciosi; Kevin A Hommel Journal: J Pediatr Date: 2010-02-01 Impact factor: 4.406
Authors: Michiko Otsuki; Michelle N Eakin; Cynthia S Rand; Arlene M Butz; Van Doren Hsu; Ilene H Zuckerman; Jean Ogborn; Andrew Bilderback; Kristin A Riekert Journal: Pediatrics Date: 2009-12 Impact factor: 7.124
Authors: Wade T A Watson; Cathy Gillespie; Nicola Thomas; Shauna E Filuk; Judy McColm; Michelle P Piwniuk; Allan B Becker Journal: CMAJ Date: 2009-08-17 Impact factor: 8.262
Authors: L B Bacharier; A Boner; K-H Carlsen; P A Eigenmann; T Frischer; M Götz; P J Helms; J Hunt; A Liu; N Papadopoulos; T Platts-Mills; P Pohunek; F E R Simons; E Valovirta; U Wahn; J Wildhaber Journal: Allergy Date: 2008-01 Impact factor: 13.146
Authors: Kevin A Hommel; Meghan E McGrady; James Peugh; George Zacur; Katherine Loreaux; Shehzad Saeed; Elizabeth Williams; Lee A Denson Journal: Inflamm Bowel Dis Date: 2017-09 Impact factor: 5.325
Authors: John E Pascoe; Hemant Sawnani; Oscar H Mayer; Keith McConnell; Joseph M McDonough; Cynthia White; Anne M Rutkowski; Raouf S Amin; Avani C Modi Journal: Pediatr Pulmonol Date: 2016-11-22
Authors: Jill M Plevinsky; Ana M Gutierrez-Colina; Julia K Carmody; Kevin A Hommel; Lori E Crosby; Meghan E McGrady; Ahna L H Pai; Rachelle R Ramsey; Avani C Modi Journal: J Pediatr Psychol Date: 2020-04-01
Authors: Charles D Varnell; Kristin L Rich; Melissa Nichols; Devesh Dahale; Jens W Goebel; Ahna L H Pai; David K Hooper; Avani C Modi Journal: Pediatr Transplant Date: 2017-08-01