Interventions to enhance patient adherence to prescribed pill medication in pediatrics: a literature review

Background/Objective: Patients frequently fail to adhere to their medication regimens, resulting in substantial public health consequences. In pediatrics, non-adherence to prescribed medication regimens ranges from 11% to 93%; averaging 50% non-adherence. Consequences of non-adherence include: inadequate or unsuccessful treatment, prolonged disease, change in prescription, prevention of accurate care assessment, and increased costs to the health care system as well as the patient. However, there is still uncertainty about the best methods to consistently enhance pill medication adherence in children enrolled in clinical trials. Therefore, a literature review was developed to include the available literature corresponding to interventions used to enhance patient adherence to pill medication in pediatric randomized controlled trials. \ud Methods: Appropriate keywords and medical subject headings were used to search Pubmed (Medline), EMBASE, CINAHL, and PsychInfo for the period from January 1966 to July 2014. Inclusion was limited to studies of randomized controlled trials, in which participants were 18 years and younger, and medication adherence was an outcome measure. Limits to the search included human subjects and English language. \ud Results: The search was developed in Pubmed and translated to the other databases to provide 1,487 total articles (935 in Pubmed, 139 in EMBASE, 258 in CINAHL, and 155 in PsychINFO). After the deletion of duplicates, 1,204 articles remained. Article titles and abstracts were reviewed to omit obvious exclusions, leaving 68 articles. A full-text review was conducted to strictly choose articles adherent to the inclusion criteria. Five articles were chosen for the literature review. \ud Conclusion: The interventions most effective at enhancing pill medication adherence were those that targeted the patient as well as their family or parent/guardian. These were especially effective when written or verbal commitments were made by the parent and/or patient to address medication adherence. Individually tailored interventions that focused on addressing behaviors associated with non-adherence were also effective. The interventions developed among the studies were mostly rated with high acceptability, feasibility, and fidelity (how well the study was executed). However the efficacy of the interventions assessed in this literature review needs to be confirmed by studies with larger sample sizes before recommended for implementation