Problem of nonadherence in chronically ill adolescents: strategies for assessment and intervention.
OBJECTIVE
Nonadherence to medical treatment is a significant problem for adolescents with chronic illness, with significant morbidity and mortality. Yet efforts to assess and treat the problem have been limited. We reviewed the literature on the factors associated with nonadherence and focused on nonadherence in a series of interviews with staff at a pediatric transplant program. This paper describes some of our findings, offers guidelines for assessing nonadherence in a primary care setting, and discusses strategies and interventions aimed at enhancing adherence. We refer to clinical cases derived from our interviews with renal transplant staff and our own clinical practice.


RESULTS
Nonadherence to treatment recommendations occurs in approximately one-third of adolescents with a chronic illness. Factors that have been associated with nonadherence include psychiatric illness, psychological factors, family issues, and health problems. Although extensive research has been done on the problem of poor patient adherence in pediatric chronic illnesses, the prevalence of nonadherence remains high, and the research itself is problematic because of different definitions and methods of assessment used. Novel treatment strategies to improve adherence have been proposed, and data on these are emerging.


CONCLUSIONS
Nonadherence in adolescents with chronic illness is a serious problem in need of greater recognition and intervention and further research. The primary care physician may be able to reduce nonadherence by routinely evaluating for adherence issues and initiating a targeted strategy to combat nonadherence when it is found. This review describes strategies and specific approaches for identifying and treating nonadherence in adolescents and their families.
Smith
Beth A
BA
Division of Child and Adolescent Psychiatry, State University of New York at Buffalo, Buffalo, New York 14222, USA. balucas@buffalo.edu
Shuchman
Miriam
M
D000293:Adolescent; D000294:Adolescent Behavior; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy; D005195:Family Relations; D006801:Humans; D010353:Patient Education as Topic; D012307:Risk Factors; D016312:Treatment Refusal / Q000523:psychology*