Improving medication adherence in children
with CF – what a pharmacist can do
Nanna Christiansen, Lead Clinical Pharmacist – Paediatrics, Barts Health NHS Trust
Jaimini Gohil, Suzanne Bishop, Nanna Christiansen
Improving medication adherencein children with CF – What a pharmacist can do?
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 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
Adherence – what we know
• Explore factors affecting medication adherence in paediatric CF patients
• Obtain patients’ opinion on pharmacist led interventions to help with adherence
Aims
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
•9 (81.8%) - necessary
•2 (18.2%) – not necessary
Helps me digest my
food
Helps my tummy aches
I don’t notice a differenc
e
63.6%
18.2%9.1% 9.1%
Vitamins & supplements
•6 (50%) - necessary
•4 (33%) – not necessary
Helps me grow
Makes me
vomit
Don’t see how it helps
Can’t see how it
makes a difference
8.3%16.6%16.6%
58.3%
Inhaled medications
• 11 children on inhaled medication
• 64% (7) adherent, 36% (4) partially adherent
•73% (8) - necessary
•27% (3) – not necessary
I don’t see a
difference
I feel better
It liquefies
my mucus
Helps me clear
bugs
Makes me breath
better
Factors affecting adherenceSimply 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%
16.7%25%
Medication information provision
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’
At home
25%
41.7%33.3%
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.CD000011.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.
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