Perceived barriers to medication adherence in pediatric and adolescent solid organ transplantation

• Authors: Lara Danziger-Isakov, Cincinnati Childrens Hospital Medical Center; Thomas W. Frazier, Cleveland Clinic; Sarah Worley, Cleveland Clinic; Nikki Williams, National Institute for Allergy and Infectious Diseases; Diana Shellmer, University of Pittsburgh; Vikas R. Dharnidharka, Washington University; Nitika Gupta, Emory University; David Ikle, Rho; Stuart C. Sweet, Washington University
• Journal Title: Pediatric Transplantation
• Volume: Volume 20, Number 2
• Publisher: Wiley: 12 months | 2016-03-01, Pages 307-315
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/petr.12648
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Pharmacology; Health Sciences, Immunology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pediatrics; Transplantation; adherence; pediatric; solid-organ transplant; RECIPIENTS; NONADHERENCE; OUTCOMES; METAANALYSIS; REGIMEN; RISK

Abstract

Comparisons of perceived barriers to adherence in pediatric and adolescent SOT have not been systematically conducted despite association between medication non-adherence and poor outcome. Fifteen centers in CTOT-C enrolled patients in a cross-sectional study. Subjects' guardians completed the PMBS and subjects over eight completed the Adolescent Scale (AMBS). Association of three identified PMBS factors and subject age was assessed. Secondary analyses assessed associations between PMBS, AMBS, and patient demographics. Three hundred sixty-eight subjects or their guardians completed PMBS or AMBS. A total of 107 subjects were 6-11 yr; 261 were ≥12. Unadjusted and propensity-adjusted analyses indicated higher perceived barriers in guardians of adolescents as compared to guardians of pre-adolescents medication scheduling and frustration domains regardless of organ (p < 0.05). PMBS and AMBS comparisons revealed that guardians reported fewer ingestion issues than patients (p = 0.018), and differences appeared more pronounced within younger responders for scheduling (p = 0.025) and frustration (p = 0.019). Screening revealed guardians of older patients report increased perceived barriers to adherence independent of socioeconomic status. Guardians of adolescents reported fewer perceived barriers to ingestion/side effects than patients themselves, particularly in pre-adolescents (8-11 yr). Brief screening measures to assess perceived barriers should be further studied in adherence improvement programs.