title: Self-management skills in adolescents with chronic rheumatic disease: A cross-sectional survey.
abstract: BACKGROUND
  For adolescents with a diagnosis of lifelong chronic illness, mastery of self-management skills is a critical component of the transition to adult care. This study aims to examine self-reported medication adherence and self-care skills among adolescents with chronic rheumatic disease.
  
  
  METHODS
  Cross-sectional survey of 52 adolescent patients in the Pediatric Rheumatology Clinic at UCSF. Outcome measures were self-reported medication adherence, medication regimen knowledge and independence in health care tasks. Predictors of self-management included age, disease perception, self-care agency, demographics and self-reported health status. Bivariate associations were assessed using the Student's t-test, Wilcoxon rank sum test and Fisher exact test as appropriate. Independence in self-management tasks were compared between subjects age 13-16 and 17-20 using the chi-squared test.
  
  
  RESULTS
  Subjects were age 13-20 years (mean 15.9); 79% were female. Diagnoses included juvenile idiopathic arthritis (44%), lupus (35%), and other rheumatic conditions (21%). Mean disease duration was 5.3 years (SD 4.0). Fifty four percent reported perfect adherence to medications, 40% reported 1-2 missed doses per week, and 6% reported missing 3 or more doses. The most common reason for missing medications was forgetfulness. Among health care tasks, there was an age-related increase in ability to fill prescriptions, schedule appointments, arrange transportation, ask questions of doctors, manage insurance, and recognize symptoms of illness. Ability to take medications as directed, keep a calendar of appointments, and maintain a personal medical file did not improve with age.
  
  
  CONCLUSIONS
  This study suggests that adolescents with chronic rheumatic disease may need additional support to achieve independence in self-management.
authors.affiliation: Department of Pediatrics, Division of Rheumatology & Immunology, University of California, San Francisco, 533 Parnassus, Rm U-127, Box 0107, San Francisco, CA 94143, USA. lawsone@peds.ucsf.edu.
authors.forename: Erica F
authors.initials: EF
authors.lastname: Lawson
authors.forename: Aimee O
authors.initials: AO
authors.lastname: Hersh
authors.forename: Mark A
authors.initials: MA
authors.lastname: Applebaum
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yelin
authors.forename: Megumi J
authors.initials: MJ
authors.lastname: Okumura
authors.forename: Emily
authors.initials: E
authors.lastname: von Scheven