title: Respiratory medication adherence in chronic lung disease of prematurity.
abstract: BACKGROUND
  Chronic lung disease of prematurity (CLDP) is a frequent complication of premature birth. Infants and children with CLDP are often prescribed complex medication regimens, which can be difficult for families to manage.
  
  
  OBJECTIVE
  We sought to determine whether non-adherence was associated with increased CLDP-related morbidities and to identify predictors of adherence.
  
  
  METHODS
  Recruited caregivers of 194 children with CLDP completed questionnaires regarding self-reported adherence, respiratory outcomes, and quality of life (January 2008-June 2010). Adherence data were available for 176 subjects, of whom 143 had self-reported data only, and 33 had prescription claims data, which were used to calculate a medication possession ratio (MPR). Participants in the Prescription Claims Sample (n = 33) were more likely to have public insurance (P < 0.001).
  
  
  RESULTS
  Self-reported adherence substantially overestimated medication possession; the mean MPR was 38.8% (n = 33) and was not associated with self-reported adherence (P = 0.71; n = 26). In a small sample, higher MPR was associated with decreased odds ratios of visiting the emergency department (ED) (OR = 0.75 for a 10% increase in MPR [95%CI: 0.58, 0.97]; P = 0.03; n = 74 questionnaires from 28 participants), activity limitations (OR = 0.71 [95%CI: 0.53, 0.95]; P = 0.02; n = 70 questionnaires from 28 participants), and rescue medication use (OR = 0.84 [95%CI: 0.73-0.98]; P = 0.03; n = 70 questionnaires from 28 participants). Increasing caregiver worries regarding medication efficacy and side effects were associated with lower MPR (P = 0.04 and 0.02, respectively; n = 62 questionnaires from 27 participants). Socio-demographic and clinical risk factors were not predictors of MPR (n = 33).
  
  
  CONCLUSIONS
  We found that non-adherence with respiratory medications was common in premature infants and children with CLDP. Using multiple timepoints in a small sample, non-adherence was associated with a higher likelihood of respiratory morbidities. Although self-reported adherence and demographic characteristics did not predict MPR, concerns about medications did. We suggest that addressing caregiver concerns about medications may improve adherence and ultimately decrease CLDP-related morbidities. Larger, prospective studies are needed to confirm these findings and determine which factors predict non-adherence.
authors: Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, David M. Rubenstein Building, 200 North Wolfe Street, Baltimore, Maryland 21287, USA. mcollac1@jhmi.edu
authors: J Michael
authors: JM
authors: Collaco
authors: Amanda J
authors: AJ
authors: Kole
authors: Kristin A
authors: KA
authors: Riekert
authors: Michelle N
authors: MN
authors: Eakin
authors: Sande O
authors: SO
authors: Okelo
authors: Sharon A
authors: SA
authors: McGrath-Morrow
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy* / Q000453:epidemiology; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D009017:Morbidity; D055656:Prescriptions / Q000706:statistics & numerical data; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016903:Drug Monitoring