Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases

Abstract

Objective: There are several factors that contribute to poor adherence to treatment in children and adolescents with chronic rheumatic diseases, worsening their quality of life and prognosis. Our aim was to assess the rates of adherence to treatment and to identify the socioeconomic and clinical factors associated. Methods:The sample included 99 patients with juvenile idiopathic arthritis, systemic erythematosus lupus, dermatomyositis or juvenile scleroderma. All patients were followed at the outpatient pediatric rheumatology for a minimum period of 6 months. To assess adherence, a questionnaire was administered to the providers, which included three blocks: 1) demographic, clinical and laboratory data; 2) medication adherence; and 3) attending follow-up appointments, examinations and use of orthoses. A value lower than or equal to 80% of the prescribed was considered poor adherence.Results: A total of 53% of patients showed good overall adherence, observed when the caregiver lived in a stable union marital status (p = 0.006); 20 patients (20.2%) presented poor medication adherence, related to the use of three or more medications daily (p = 0.047). The causes of poor adherence were forgetfulness, refusal, incorrect dose or lack of medication, personal problems, and financial difficulties. Conclusions:We observed good overall treatment adherence in patients whose providers lived in stable union and poor adherence to medication in patients who used more than three types of medication daily. There was no association between the adherence rates and sex, age, time since diagnosis and disease activity. J Pediatr (Rio J). 2012;88(6):483-8:Patient adherence, therapy, chronic disease, pediatrics, rheumatology. ResumoObjetivo: São vários os fatores que contribuem para a má adesão ao tratamento de crianças e adolescentes com doenças reumáticas crônicas, gerando piora da qualidade de vida e do prognóstico. Nosso objetivo foi avaliar as taxas de adesão ao tratamento e identificar os fatores socioeconômicos e clínicos associados. Métodos:Foram incluídos 99 pacientes com artrite idiopática juvenil, lúpus eritematoso sistêmico, dermatomiosite ou esclerodermia juvenil. Todos os pacientes eram acompanhados no ambulatório de reumatologia pediátrica por um período mínimo de 6 meses. Para avaliação da adesão, foi aplicado aos cuidadores um questionário composto por três blocos: 1) dados demográficos, clínicos e laboratoriais; 2) adesão ao tratamento medicamentoso; e 3) comparecimento às consultas, realização de exames e utilização de órteses. Foi considerada má adesão, quando realizado valor menor ou igual a 80% do prescrito.Resultados: Um total de 53% dos pacientes apresentou boa adesão ao tratamento global, observada quando o cuidador possuía união estável (p = 0,006); 20 pacientes (20,2%) apresentaram má adesão ao tratamento medicamentoso, relacionada à utilização de mais que três medicamentos diários (p = 0,047). As causas de má adesão ao tratamento foram esquecimento, recusa, dose incorreta ou falta de medicamento, prob...

Harnessing interactive technologies to improve health outcomes in juvenile idiopathic arthritis

“…Adherence to medications including methotrexate and biological-drugs remains a significant issue in paediatric rheumatology, with alarming reports that as few as 53% of children with rheumatic disease (RD) have good overall drug-adherence [12]. Bugni et al (2012) reported that 20 children with RD, equivalent to 20.2% of the participant recruited, had poor medication adherence related to the use of three or more daily medications (p = 0.047).…”

“…Bugni et al (2012) reported that 20 children with RD, equivalent to 20.2% of the participant recruited, had poor medication adherence related to the use of three or more daily medications (p = 0.047). Specifically to children with JIA, 28(51%) patients were not adherent to the prescribed medication [12].…”

“…Bugni et al (2012) reported that 20 children with RD, equivalent to 20.2% of the participant recruited, had poor medication adherence related to the use of three or more daily medications (p = 0.047). Specifically to children with JIA, 28(51%) patients were not adherent to the prescribed medication [12]. Pelajo et al (2012) investigated 76 outpatients and the overall rate of non-adherence to methotrexate was 18% amongst American and Portuguese children with JIA, between 1 and 17 years old.…”

“…Interestingly, the main reason for non-adherence in Boston was "child refused", while in Rio de Janeiro non-adherence was mostly related to an inability to acquire the medication [13]. Multiple reasons should be considered when addressing medication adherence, such as child refusal, adverse effects or lack of medication availability, personal issues, and financial hardship [12]. Another major reason for adherence failure is forgetfulness [12]; therefore, in order to encourage children to take their prescribed drugs, parents/carers are often essential to ensuring adherence.…”

“…Multiple reasons should be considered when addressing medication adherence, such as child refusal, adverse effects or lack of medication availability, personal issues, and financial hardship [12]. Another major reason for adherence failure is forgetfulness [12]; therefore, in order to encourage children to take their prescribed drugs, parents/carers are often essential to ensuring adherence. It is possible that smart reminders, accessible directly from the patient's mobile or tablet, may assist medication adherence.…”