title: The impact of effective paediatric adherence promotion interventions: systematic review and meta-analysis.
abstract: BACKGROUND
  Understanding the impact of effective paediatric adherence promotion interventions on patients, families and the healthcare system is necessary to inform efforts to improve healthcare quality and control costs. Building on previous research suggesting that improving adherence may have far-reaching benefits, the objective of this study was to quantify the impact of effective adherence promotion interventions for children and adolescents with a chronic medical condition on patients, families and the healthcare system.
  
  
  METHODS
  Authors systematically reviewed articles indexed in PubMed, PsycINFO and CINAHL to identify randomized controlled trials of paediatric adherence promotion interventions. Interventions that improved paediatric adherence and examined patient-level, family-level or healthcare system-level outcomes in children and adolescents (M age ≤ 18 years) with a chronic medical condition were included. Two authors independently extracted and classified outcome variables as patient-level (quality of life and disease-related activity restrictions), micro-level (family functioning, family conflict, caregiver quality of life, caregiver sleep interruption, caregiver days away from work and patient missed school days) or macro-level variables (emergency department visits, hospitalizations, outpatient visits and urgent care visits). Outcome variables detailed in previously published reviews (i.e. disease severity) were excluded.
  
  
  RESULTS
  Twenty studies representing 19 unique samples met inclusion criteria. An additional eight articles representing trials that did not significantly improve adherence were included in post hoc analyses. Compared with control interventions, effective paediatric adherence promotion interventions improved patient quality of life and family-level outcomes and decreased healthcare utilization among children and adolescents with a chronic medical condition.
  
  
  CONCLUSIONS
  Interdisciplinary efforts to improve healthcare quality and reduce spending among children and adolescents with a chronic medical condition may be enhanced by incorporating effective paediatric adherence promotion interventions. As relatively few chronic medical conditions were represented in included studies, future research should examine the impact of paediatric adherence promotion interventions in other populations.
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: McGrady
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Ryan
authors.affiliation: Psychology Department, University of Georgia, Athens, GA, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Gutiérrez-Colina
authors.affiliation: Child Health Evaluation and Research Unit (CHEAR), Division of Child Behavioral Health, University of Michigan and C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Fredericks
authors.affiliation: Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Towner
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: A L H
authors.initials: AL
authors.lastname: Pai
mesh_terms: D000293:Adolescent; D015982:Bias; D002648:Child; D002908:Chronic Disease / Q000188:drug therapy*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D055118:Medication Adherence; D058996:Quality Improvement; D011788:Quality of Life
keywords: medication adherence; paediatrics; quality of life