Facilitators and Barriers of Medication Adherence in Pediatric Liver and Kidney Transplant Recipients: A Mixed-Methods Study

Claes, A.; Decorte, Anneloes; Levtchenko, Elena; Knops, Noël; Dobbels, Fabienne

doi:10.7182/pit2014873

Cited by 21 publications

(25 citation statements)

References 17 publications

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“…The most reported barrier to adherence was forgetfulness and vomiting (70%), followed by bad taste and interruptions in routine (60%). Parents reported that adherence facilitators included using practical reminder aids and having medication with you at all times (100%), having to take fewer medications and experiencing fewer regimen changes over time (80%) . The medication regimen should be clear and simplified as possible.…”

Section: Adherence and Transition Of Carementioning

confidence: 99%

“…Parents reported that adherence facilitators included using practical reminder aids and having medication with you at all times (100%), having to take fewer medications and experiencing fewer regimen changes over time (80%). (75) The medication regimen should be clear and simplified as possible. Developing strategies to identify and treat nonadherence is clinically imperative.…”

Section: Adherence and Transition Of Carementioning

confidence: 99%

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Immunosuppression in pediatric liver transplant recipients: Unique aspects

et al. 2017

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Pediatric liver transplantation has experienced improved outcomes over the last 50 years. This can be attributed in part to establishing optimal use of immunosuppressive agents to achieve a balance between minimizing the risks of allograft rejection and infection. The management of immunosuppression in children is generally more complex and can be challenging when compared with the use of these agents in adult liver transplant patients. Physiologic differences in children alter the pharmacokinetics of immunosuppressive agents, which affects absorption, distribution, metabolism, and drug excretion. Children also have a longer expected period of exposure to immunosuppression, which can impact growth, risk of infection (bacterial, viral, and fungal), carcinogenesis, and likelihood of nonadherence. This review discusses immunosuppressive options for pediatric liver transplant recipients and the unique issues that must be addressed when managing this population. Further advances in the field of tolerance and accommodation are needed to relieve the acute and cumulative burden of chronic immunosuppression in children.Liver Transplantation 23 244-256 2017 AASLD.

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Section: Adherence and Transition Of Carementioning

confidence: 99%

Section: Adherence and Transition Of Carementioning

confidence: 99%

Immunosuppression in pediatric liver transplant recipients: Unique aspects

et al. 2017

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“…The experiences of children, and families, taking medication have been described for asthma [5, 6], diabetes [6], cystic fibrosis [7, 8], attention deficit hyperactivity disorder [9], inflammatory bowel disease [10], diabetes [11] and post-transplant patients [12, 13]. Challenges were described around medication use in school, taking in front of peers, social activities, regimen rigidity, reliance on family and adherence.…”

Section: Introductionmentioning

confidence: 99%

The treatment-related experiences of parents, children and young people with regular prescribed medication

2018

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Background Taking regular medication has been shown to have an impact on the daily lives of patients and their families. Objective To explore the medication-related experiences of patients and their families when a child or young person is prescribed regular medication. Setting A specialist U.K. paediatric hospital. Method Semi-structured face-to-face interviews of 24 parents/carers, children or young people, who had been taking two or more medications for 6 weeks or longer. The themes explored included the medication regimen, formulation, supplies, social aspects and adverse effects. The data was analysed using NVIVO version 11. Main outcome measure The experiences of patients, and their parents/carers, when a child/young person takes regular medication. Results Participants described a range of experiences associated with taking regular medication. Medication-related challenges were experienced around the timing of administration which was managed over 24 h rather than waking hours. Updating medication doses for administration at school was often delayed. Unintended nonadherence was cited as the biggest challenge with a range of strategies employed to manage this. The internet was commonly used as a source of additional information accessed for reassurance and adverse effects but there were varying experiences of using patient forums/help groups. Other challenges included the adequacy of information, travelling with medication, formulation issues, arranging supplies and adverse effects. Conclusion Patients and parents experience many challenges with children’s medication. Individualised treatment options should be considered. Further research is required to determine how these experiences may be managed including the role of paediatric medication review.

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“…These results are both consistent and conflicting with published patient and parent beliefs. Patients and parents often cite forgetfulness as a common reason for adolescent non‐adherence in many disease processes including solid‐organ transplantation . In a study assessing medication adherence in adolescent liver transplant recipients, Shemesh et al.…”

Section: Discussionmentioning

confidence: 99%

Medication adherence among adolescent solid‐organ transplant recipients: A survey of healthcare providers

Mehta

Steinberg

Kelly

et al. 2017

Pediatric Transplantation

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The aim of this study was to assess healthcare provider perspectives on barriers to medication adherence and to discover recommendations for interventions among providers of pediatric solid-organ transplant patients. An anonymous online survey was administered to a multidisciplinary pool of pediatric transplant providers from February 2015 to March 2016. It consisted of 15 questions regarding transplant providers' attitudes, clinical practice, and beliefs pertaining to medication adherence among teenage solid-organ transplant recipients. Data were analyzed using descriptive statistics. Responses to open-ended questions were coded and categorized into themes. One hundred ten surveys were completed by providers specializing in pediatric heart, kidney, liver, lung, and/or intestinal transplantation. Commonly cited reasons for poor adherence were forgetting/poor planning (94%), the desire to be normal (86%), lack of support (86%), and poor parental monitoring (79%). Suggestions to improve adherence included increasing peer and family support, providing education, and incorporating technology into adherence regimens. Barriers to adherence in transplant patients are recognized by providers and are both similar to and disparate from patient and family identified barriers published in the literature. Providers recognize the importance of education, social support, and technologically driven interventions on improving outcomes in the transplant population.

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Facilitators and Barriers of Medication Adherence in Pediatric Liver and Kidney Transplant Recipients: A Mixed-Methods Study

Abstract: This study provides several new insights based on peer experience to support future patients and their parents in medication adherence.

Cited by 21 publications

References 17 publications

Immunosuppression in pediatric liver transplant recipients: Unique aspects

Immunosuppression in pediatric liver transplant recipients: Unique aspects

The treatment-related experiences of parents, children and young people with regular prescribed medication

Medication adherence among adolescent solid‐organ transplant recipients: A survey of healthcare providers

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