title: Electronic monitoring feedback to promote adherence in an adolescent with Fanconi Anemia.
abstract: OBJECTIVE
  This report describes an intervention to promote medication adherence and treat comorbid psychological symptoms in a 17 year-old female with Fanconi Anemia. The patient presented with a typical adherence rate estimated at 25% and self-reported symptoms of depressed mood and anxiety.
  
  
  METHODS
  Our comprehensive treatment approach integrated electronic monitoring (EM), an emerging strategy for adherence promotion, and motivational interviewing (MI) within an evidence-based cognitive-behavioral therapy (CBT) framework. We used EM data to assess and track medication adherence. The therapist reviewed these data with the patient and family in session and used MI techniques to promote health behavior change. We analyzed changes in adherence rates over time using a time series analysis (Auto-Regressive Moving Average [ARIMA]). In addition, the patient and her mother reported on depression, anxiety, and quality of life at intake and after 12 months, and the therapist treated psychological symptoms with CBT.
  
  
  RESULTS
  The average adherence rate during the baseline EM phase was ~53%. The mean adherence rate across treatment was ~77%, and after 17 months, the final weekly adherence rate was 82%. Adherence rates significantly improved over the treatment period, ARIMA t = 36.16, p < .01.
  
  
  CONCLUSIONS
  EM feedback and MI are viable additions to CBT to promote medication adherence in adolescence. This approach has the potential to effectively treat adolescents with adherence problems and psychological symptoms across multiple chronic illness diagnoses, and ultimately to improve health and quality of life 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, USA. marisa.hilliard@cchmc.org
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Hilliard
authors.forename: Christina
authors.initials: C
authors.lastname: Ramey
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Rohan
authors.forename: Dennis
authors.initials: D
authors.lastname: Drotar
authors.forename: Sandra
authors.initials: S
authors.lastname: Cortina
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000150:complications / Q000628:therapy*; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000150:complications / Q000628:therapy*; D001330:Electronic Data Processing; D005199:Fanconi Anemia / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007406:Interview, Psychological; D055118:Medication Adherence; D008991:Monitoring, Physiologic; D011788:Quality of Life; D016896:Treatment Outcome