Background/Purpose:

Children with rheumatic diseases are often prescribed complex medication regimens.  Medication side-effects may have a negative impact on physical appearance and subsequently impact adherence.  In children with rheumatic disease, non-adherence can lead to serious consequences such as decreased physical function, increased symptomology, and hospitalizations requiring more invasive and costly treatment.  The purpose of this study is to examine parent and child report of medication adherence in children with rheumatic disease ages 8-18 years.  Additionally, this study examines the extent to which health related quality of life (HRQOL) is associated with medication adherence.  Adherence will also be examined for its relationship to other psychosocial variables, risk of depression and pain. 

Methods:

One hundred fifty children with rheumatic disease followed at a Midwest children’s hospital were recruited at an outpatient rheumatology appointment. Each parent-child pair completed measures assessing adherence to the child’s medication regimen, demographic variables, HRQOL assessed using the Pediatric Quality of Life Rheumatology module (PedsQLRM), depressive symptoms assessed using the Childhood Depression Inventory, and reported pain as assessed by visual analog scale and individual items from the aforementioned standardized measures.  Appropriate parametric statistics were completed to determine statistical significance of demographic variables. MANOVAs were used to determine the relationship between HRQOL, pain, risk of depression and medication adherence. Data was analyzed using SPSS 16.0.  

Results:

Eighty-seven percent of the children in the sample were prescribed medication for their illness.  Parent and child report of medication compliance showed significant correlation (r= .229, p<.009).  Twenty percent of parents reported that their child missed two or more doses of medication within the prior week.  One third of patients reported missing two or more doses of medication within the past week, with 8.6% reported missing 4 or more doses. One-third of the sample reported complete compliance with medications.  Demographic variables that were significantly related to medication compliance were parent marital status (p<.032), parent employment (p<.043), gender (p<.038), and child age (p<.034).  Medication non-adherence was associated with trouble sleeping (p<.032), report of side effects (p<.011), worry (p<.013) and total quality of life score (p<.046) based on child report.  Neither risk of depression nor pain, as reported on the PedsQLRM, were found to be significantly related to medication compliance.

Conclusion:

Rates of medication non-adherence in this population are high, and while children and their parents report a moderate correlation, results suggest that parents underestimate their child’s medication adherence.  A better understanding of key demographic, psychosocial and HRQOL variables associated with adherence may allow the physician to address non-adherence directly with at risk patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/medication-adherence-and-quality-of-life-in-children-with-rheumatic-disease/