Study: Long-Term Medication Adherence Hinges on Two Factors
A new research study suggests that, in the short term, a child will stick to his or her new ADHD treatment plan if the pediatrician adequately explains both the condition and its treatment options, and if symptom control is evident with medication. In the long term, adherence hinges on the child’s acceptance of the medication and his or her parents’ beliefs about its risks and rewards.
November 2, 2018
What factors help to predict whether a child will adhere to his or her ADHD medication regimen during the first three months of treatment? A new study by researchers at Cincinnati Children’s Hospital suggests that three factors influence treatment-plan adherence in the first 90 days:
- parental beliefs about ADHD
- parental satisfaction with the information received from the prescribing physician
- and greater reduction in symptoms
These factors vary significantly from those that predict long-term adherence, the study contends. The main predictors for adherence beyond the first 90 days were two:
- the child’s acceptance of the medication
- the difference between the parents’ perception of the need for treatment and their concerns about medication
In addition, the researchers noted a negative correlation between a child’s dislike of the medication and his or her long-term adherence.
This study suggests that pediatricians can ensure short-term adherence to a new ADHD medication by making sure parents are well-informed, and by titrating medication promptly to minimize side effects while reducing ADHD symptoms. In the long-term, the results suggest that pediatricians may have less of a direct role in ensuring adherence, though they can help by seeing patients regularly and addressing the treatment concerns of both parents or children.
Adherence was stronger in the short term overall, with a median of 81% of days covered during the first 90 days of the study, and a median of 54% of days covered in the remainder of the year.
The 89 child participants in the study were drawn from 44 pediatricians and practices in the Cincinnati area between 2010 and 2013. All were 6 to 10 years old at the time of their original diagnosis and had not been medicated for ADHD prior to the study. 90% of the children received an extended-release stimulant as their initial medication; 7% received an immediate-release stimulant; and the remainder received other medications.
Before the study, parents completed validated surveys on their beliefs about ADHD and medication, as well as their perception of their pediatrician and of the information provided to them on their initial visit. Parents also rated their children’s literacy and numeracy, psychological distress, quality of life, and behavior and symptoms specific to ADHD. The parents were assessed themselves to determine their own beliefs about ADHD and ADHD medication, and their comfort with the decision to medicate. The working relationship between parent and pediatrician was also evaluated.
At the end of the study, a chart review evaluated the number of physician visits and prescriptions for each patient, as well as any titration during the first three months of treatment and the quality and frequency of patient monitoring.
Adherence during the latter period was not predicted by baseline factors, leading researchers to ascertain that adherence was subject to fluctuating perceptions of medication and experiences with treatment in both parents and children.