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Pediatric patients with sickle cell disease showed moderate medication adherence
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Medication adherence was adequate among pediatric patients with sickle cell disease, indicating a need to improve adherence through multicomponent interventions, according to study findings.
“Poor adherence reduces the effectiveness of medications, places patients at risk for serious complications, and significantly increases health care costs,” Kathleen E. Walsh, MD, MSc, associate professor of pediatrics at Cincinnati Children’s Hospital, and colleagues wrote. “Nonadherence is estimated to account for $100 billion to $300 billion in annual US health care costs.”
Kathleen E. Walsh
The researchers conducted a systematic review of literature examining medication adherence among patients aged younger than 25 years with sickle cell disease. After applying various exclusions based on drug type, study populations and study designs, the researchers identified 24 studies for inclusion. Twenty-three articles pertained to one medication type only. Of these, 13 addressed antibiotic prophylaxis, five focused on iron chelation, and five analyzed hydroxyurea.
In terms of overall adherence, there was a range from 16% to 89%, with moderate adherence observed in most studies. Certain medication factors, such as drug delivery, influenced adherence. In the case of antibiotics, intramuscular injection was associated with better adherence than oral delivery.
Barriers to compliance included concerns regarding side effects, incorrect dosing, and forgetting to take medication. Nonadherence to medications was related to an increase in vaso-occlusive crises and hospitalizations. The researchers found that patients achieved some clinical benefit through moderate adherence to hydroxyurea and iron chelation regimens.
“Because good adherence is uncommon, we suggest clinicians use routine monitoring of adherence, including parent report and objective measures,” the researchers wrote. “Multicomponent interventions should target health beliefs and mistakes in medication administration; educational interventions alone are less likely to be effective. Randomized trials of multicomponent interventions, addressing beliefs and mistakes, are needed to help clinicians optimize outcomes by improving medication adherence.”
Disclosure: The researchers report no relevant financial disclosures.
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