Identifying youth nonadherence in clinical settings: data-based recommendations for children and adolescents with inflammatory bowel disease.
BACKGROUND
To examine the validity of patient self-report of thiopurine adherence in pediatric inflammatory bowel disease (IBD) against an objective electronic monitoring adherence measure, and to investigate the role of youth and maternal involvement in remembering to take daily medications as predictors of medication adherence.


METHODS
Fifty-one youths with IBD, ages 11-18 years, participated. Youths completed questionnaire assessments of their own and their maternal caregiver's involvement in remembering to take daily medications at baseline, completed monthly interviews assessing thiopurine adherence over the past week for a period of 6 months, and utilized a Medication Events Monitoring System (MEMS) electronic monitor for their thiopurine medication for 6 months. Participants were grouped into adherent (at least 80% of doses taken based on objective MEMS caps) or nonadherent for analyses.


RESULTS
Youths who were nonadherent based on electronic monitoring overestimated their adherence by 23%, whereas adherent youths overestimated their adherence by only 2%, and as such patient self-report offered little utility in identifying youths who were nonadherent. Youths who reported high levels of involvement in remembering to take their medications were nearly eight times less likely to be nonadherent.


CONCLUSIONS
The current findings provide evidence that clinicians who work with children and adolescents with IBD may benefit from modifying their approach to nonadherence screening. Asking about youth involvement in remembering daily medications may be more informative than asking them to recall their medication-taking behavior over the last week in identifying those at highest risk for nonadherence.
Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois 60064, USA. rachel.greenley@rosalindfranklin.edu
Rachel Neff
RN
Greenley
Jennifer Hauser
JH
Kunz
Vincent
V
Biank
Alfonso
A
Martinez
Adrian
A
Miranda
Joshua
J
Noe
Grzegorz
G
Telega
Neelesh Ajit
NA
Tipnis
Steven
S
Werlin
Michael C
MC
Stephens
D000293:Adolescent; D017028:Caregivers; D002648:Child; D016208:Databases, Factual; D016903:Drug Monitoring; D005190:Family; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D015122:Mercaptopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D057566:Self Report; D011795:Surveys and Questionnaires
D007166:Immunosuppressive Agents; C488629:azathiopurine; D015122:Mercaptopurine