title: Perceived barriers to medication adherence in pediatric and adolescent solid organ transplantation.
abstract: Comparisons of perceived barriers to adherence in pediatric and adolescent SOT have not been systematically conducted despite association between medication non-adherence and poor outcome. Fifteen centers in CTOT-C enrolled patients in a cross-sectional study. Subjects' guardians completed the PMBS and subjects over eight completed the Adolescent Scale (AMBS). Association of three identified PMBS factors and subject age was assessed. Secondary analyses assessed associations between PMBS, AMBS, and patient demographics. Three hundred sixty-eight subjects or their guardians completed PMBS or AMBS. A total of 107 subjects were 6-11 yr; 261 were ≥12. Unadjusted and propensity-adjusted analyses indicated higher perceived barriers in guardians of adolescents as compared to guardians of pre-adolescents medication scheduling and frustration domains regardless of organ (p < 0.05). PMBS and AMBS comparisons revealed that guardians reported fewer ingestion issues than patients (p = 0.018), and differences appeared more pronounced within younger responders for scheduling (p = 0.025) and frustration (p = 0.019). Screening revealed guardians of older patients report increased perceived barriers to adherence independent of socioeconomic status. Guardians of adolescents reported fewer perceived barriers to ingestion/side effects than patients themselves, particularly in pre-adolescents (8-11 yr). Brief screening measures to assess perceived barriers should be further studied in adherence improvement programs.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Lara
authors.initials: L
authors.lastname: Danziger-Isakov
authors.affiliation: Cleveland Clinic Children's, Cleveland, OH, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Frazier
authors.affiliation: Cleveland Clinic Children's, Cleveland, OH, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.affiliation: National Institute for Allergy and Infectious Diseases, Bethesda, MD, USA.
authors.forename: Nikki
authors.initials: N
authors.lastname: Williams
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Shellmer
authors.affiliation: St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Nitika A
authors.initials: NA
authors.lastname: Gupta
authors.affiliation: Rho, Chapel Hill, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ikle
authors.affiliation: St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Sweet
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D055118:Medication Adherence; D016377:Organ Transplantation; D010290:Parents; D010372:Pediatrics / Q000379:methods; D012923:Social Class; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: adherence; pediatric; solid-organ transplant