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scientific articles

Medication adherence among pediatric patients with sickle cell disease: a systematic review

key information

source: Pediatrics

year: 2014

authors: Walsh KE, Cutrona SL, Kavanagh PL, Crosby LE, Malone C, Lobner K, Bundy DG

summary/abstract:

OBJECTIVES:
Describe rates of adherence for sickle cell disease (SCD) medications, identify patient and medication characteristics associated with nonadherence, and determine the effect of nonadherence and moderate adherence (defined as taking 60%-80% of doses) on clinical outcomes.
METHODS:
In February 2012 we systematically searched 6 databases for peer-reviewed articles published after 1940. We identified articles evaluating medication adherence among patients RESULTS:
Of 24 articles in the final review, 23 focused on 1 medication type: antibiotic prophylaxis (13 articles), iron chelation (5 articles), or hydroxyurea (5 articles). Adherence rates ranged from 16% to 89%; most reported moderate adherence. Medication factors contributed to adherence. For example, prophylactic antibiotic adherence was better with intramuscular than oral administration. Barriers included fear of side effects, incorrect dosing, and forgetting. Nonadherence was associated with more vaso-occlusive crises and hospitalizations. The limited data available on moderate adherence to iron chelation and hydroxyurea indicates some clinical benefit.
CONCLUSIONS:
Moderate adherence is typical among pediatric patients with SCD. Multicomponent interventions are needed to optimally deliver life-changing medications to these children and should include routine monitoring of adherence, support to prevent mistakes, and education to improve understanding of medication risks and benefits.

organisation: University of Cincinnati School of Medicine; Meyers Primary Care Institute, Worcester; University of Massachusetts; Boston University; Johns Hopkins Medical Center, Baltimore;Medical University of South Carolina

DOI: 10.1542/peds.2014-0177

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