Transcript Adherence
Improving medication adherence in children with CF – what a pharmacist can do Nanna Christiansen, Lead Clinical Pharmacist – Paediatrics, Barts Health NHS Trust Improving medication adherence in children with CF – What a pharmacist can do? Jaimini Gohil, Suzanne Bishop, Nanna Christiansen Background to Cystic Fibrosis Medical management requires wide range of medication: - digestive enzymes - vitamins and supplements - bronchodilators - mucolytics - inhaled, PO or IV antibiotics - anti-reflux - insulin Adherence – what we know • Adherence differs depending on – Complexity and number of medicines – Palatability – Immediate effect associated with intake – Duration of treatment – Time needed to take the medication – Patient factors • Adherence rate around 50% can be expected for CF Aims • Explore factors affecting medication adherence in paediatric CF patients • Obtain patients’ opinion on pharmacist led interventions to help with adherence Methodology • Cross sectional study • Data collection using self-reported questionnaire • Inclusion criteria: • • • • Between 11 to 16 years Confirmed diagnosis of CF Able to read and understand English Able to fill in the questionnaire themselves • Exclusion criteria: • Children in terminal phase of illness Questionnaire • Section A – Demographics • Section B – Adherence to different medication – Children's perception of necessity of medication – Reasons for non-adherence • Section C – Assessment of pharmacist led interventions Results • 17 eligible patients, 12 took part Pancreatic enzymes 63.6% 18.2% 9.1% •9 (81.8%) - necessary •2 (18.2%) – not necessary 9.1% Helps my tummy aches I don’t notice a difference Helps me digest my food Vitamins & supplements 58.3% 16.6% 16.6% 8.3% •6 (50%) - necessary Helps me grow •4 (33%) – not necessary Can’t see how it makes a difference Makes me vomit Don’t see how it helps Inhaled medications • 11 children on inhaled medication • 64% (7) adherent, 36% (4) partially adherent •73% (8) - necessary I feel better Helps me clear bugs Makes me breath better It liquefies my mucus •27% (3) – not necessary I don’t see a differenc e Factors affecting adherence Simply forgot: 41.7% - 58.3% Don’t like the taste – 16.7% Don’t want my friends to know 8.3% Not important – 8.3% Pharmacist led interventions • Interventions described in literature: • • • • Written (PIL) and oral communication (counselling) Telephone based follow up Reminder charts Pill boxes 58.3% 25% 16.7% Medication information provision At home 41.7% 33.3% 25% New medication – 67% receive information from doctor - 33% have not been given information Pharmacist at clinic – 50% ‘would not make a difference’ - 50% ‘would help in providing information on CF meds’ Conclusion • Reported adherence levels slightly higher than in literature • Unique information on children’s perception and preferred interventions In practice: • Useful information for pharmacist in clinic • Child friendly drug information provision References • Bucks RS, Hawkins K, Skinner TC et al. Adherence to treatment in adolescents with cystic fibrosis: the role of illness perceptions and treatment beliefs. J Pediatr Psychol, 2009;34:893-902 • Haynes RB, Ackloo E, Sahota N et al. Interventions for enhancing medication adherence. Cochrane DatabaseSystRev.2008Apr16;(2):CD000011.doi:10.1002/14651858.CD0000 11.pub3. • Modi AC, Lim CS, Yu N et al. A multi-method assessment of treatment adherence for children with cystic fibrosis. Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society, 2006; 5:177-185. • Segal TY Adolescence: what the cystic fibrosis team needs to know. J r Soc Med, 2008;101:15-27 • Quittner AL, Espelage DL, Ievers-Landis C, Drotar D. Measuring adherence to medical treatments in childhood chronic illness: Considering multiple methods and sources of information. Journal of Clinical Psychology in Medical Settings, 7, 41-54.