title: Individually tailored treatment of medication nonadherence.
abstract: OBJECTIVE
  Nonadherence is a significant health care issue in pediatric inflammatory bowel disease (IBD) that requires intervention to improve outcomes. This pilot randomized controlled trial was designed to evaluate the feasibility, acceptability, and preliminary efficacy of an individually tailored behavioral treatment for nonadherence in adolescents with IBD.
  
  
  METHODS
  Fourteen adolescents ages 14.89 ± 2.01 years were randomly assigned to immediate care or wait list control conditions and received a manualized individually tailored behavioral intervention for nonadherence. Medication adherence, measured by pill count, served as the primary endpoint. Parents provided demographic data and ratings of intervention acceptability and patients provided disease-severity data.
  
  
  RESULTS
  Feasibility of the treatment was demonstrated by 100% treatment session attendance for all of the patients enrolled in the trial. Both parent and patient acceptability ratings were favorable. Comparison of baseline with posttreatment percent adherence across both conditions demonstrated that treatment resulted in a 4% gain in 6-mercaptopurine/azathioprine adherence (52% at baseline; 56% at posttreatment; δ = 0.07) and a 25% gain in mesalamine adherence (43% at baseline; 68% at posttreatment; δ = 0.57).
  
  
  CONCLUSIONS
  Individually tailored treatment of nonadherence in adolescents with IBD is feasible and may result in substantial improvement in medication adherence. Differential effect of the intervention on medications requires further investigation, but it may reflect differences in regimen complexity, concerns about medication adverse effects, and/or patient/parent preference to target more complex regimens. Large-scale testing of this intervention is needed to demonstrate effect on clinical outcomes.
authors.affiliation: Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. kevin.hommel@cchmc.org
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Hommel
authors.forename: Michele
authors.initials: M
authors.lastname: Herzer
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Ingerski
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hente
authors.forename: Lee A
authors.initials: LA
authors.lastname: Denson
mesh_terms: D000293:Adolescent; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D015122:Mercaptopurine / Q000627:therapeutic use; D019804:Mesalamine / Q000627:therapeutic use; D010353:Patient Education as Topic; D010865:Pilot Projects; D057285:Precision Medicine; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D019804:Mesalamine; D015122:Mercaptopurine; D001379:Azathioprine