Individually tailored treatment of medication nonadherence
Open accessAbstract
Objective: Nonadherence is a significant health care issue in pediatric inflammatory bowel disease (IBD) that requires intervention to improve outcomes. This pilot randomized controlled trial was designed to evaluate the feasibility, acceptability, and preliminary efficacy of an individually tailored behavioral treatment for nonadherence in adolescents with IBD. Patients and Methods: Fourteen adolescents ages 14.89 ± 2.01 years were randomly assigned to immediate care or wait list control conditions and received a manualized individually tailored behavioral intervention for nonadherence. Medication adherence, measured by pill count, served as the primary endpoint. Parents provided demographic data and ratings of intervention acceptability and patients provided disease‐severity data. Results: Feasibility of the treatment was demonstrated by 100% treatment session attendance for all of the patients enrolled in the trial. Both parent and patient acceptability ratings were favorable. Comparison of baseline with posttreatment percent adherence across both conditions demonstrated that treatment resulted in a 4% gain in 6‐mercaptopurine/azathioprine adherence (52% at baseline; 56% at posttreatment; δ = 0.07) and a 25% gain in mesalamine adherence (43% at baseline; 68% at posttreatment; δ = 0.57). Conclusions: Individually tailored treatment of nonadherence in adolescents with IBD is feasible and may result in substantial improvement in medication adherence. Differential effect of the intervention on medications requires further investigation, but it may reflect differences in regimen complexity, concerns about medication adverse effects, and/or patient/parent preference to target more complex regimens. Large‐scale testing of this intervention is needed to demonstrate effect on clinical outcomes.
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Parents gave higher ratings than adolescents for two interventions by Hommel et al. to promote medication adherence.
“and parents gave higher ratings than adolescents for two interventions by Hommel et al. to promote medication adherence 26, 27 .”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [27]
The Methods describe parent and adolescent ratings of this medication-adherence intervention, and the Discussion says both groups rated its acceptability favorably. The passages do not establish that parents gave higher ratings than adolescents. This paper evaluates one intervention; the other intervention in the citing sentence may be covered by its second citation. (LLM, conf=0.82)
Experimental — accuracy not yet measuredParents thought the format was helpful more than adolescents (6.50 vs 5.43).
“and thought the format was helpful (6.50 vs 5.43).”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as Hommel et al (2011)
The Methods (page unavailable) say the questionnaire asked patients and parents about the intervention’s format, and the Discussion (page unavailable) says both groups rated the intervention favorably. The passages do not give format-helpfulness scores of 6.50 and 5.43 or establish that parents rated it higher than adolescents. (LLM, conf=0.78)
Experimental — accuracy not yet measuredParents felt that the treatment improved their child's adherence more than adolescents (5.92 vs 5.43).
“and felt that the treatment improved their child's adherence (5.92 vs 5.43).”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as Hommel et al (2011)
The Measures section says parents and patients rated their perception of the treatment’s effect on adherence, and the Abstract Results reports favorable ratings from both groups. The passages in our copy do not give the claimed scores of 5.92 and 5.43 or establish that parents rated the improvement higher than adolescents; Results refers those ratings to Table 2 without reproducing them here. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThree interventions used skills training to improve medication adherence.
“Three interventions used skills training to improve medication adherence 25,26, 27 .”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [27]
Hommel et al. 2011 found a beneficial effect on adherence to one but not both of the assessed IBD medications.
“Hommel et al. 2011 found a beneficial effect on adherence to one but not both of the assessed IBD medications 27 .”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [27]
Treatment satisfaction and acceptability was measured in four trials and ratings were mostly positive.
“Treatment satisfaction and acceptability was measured in four trials (.,Hommel et al. 2012., Hommel et al. 2011, Reigada et al.) 25-28 and ratings were mostly positive.”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [27]
Three trials assessed medication adherence but findings were inconsistent.
“Three trials assessed medication adherence 25-27 but findings were inconsistent.”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [27]
No statistically significant difference was found in post-intervention adherence to mesalamine (t=1.09, p=0.31).
“but not mesalamine (t=1.09, p=0.31)”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as Hommel et al (2011)
Parents used the behavioural skills more than adolescents (5.15 vs 4.79).
“Parents used the behavioural skills more (5.15 vs 4.79)”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as Hommel et al (2011)
The Measures section says the questionnaire assessed the extent to which parents used behavioral skills. The Results section refers to parent and patient ratings in Table 2, but the passages available from our copy do not give 5.15 or 4.79 or establish that parents used the skills more than adolescents. Searches for both numbers and the parent–adolescent comparison did not resolve the claim. (LLM, conf=0.70)
Experimental — accuracy not yet measured
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Cites
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- Authors
- Hommel, K. A., Herzer, M., Ingerski, L. M., Hente, E., & Denson, L. A.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Hommel, Kevin A.
- Herzer, Michele
- Ingerski, Lisa M.
- Hente, Elizabeth
- Venue
- Journal of Pediatric Gastroenterology and Nutrition
- Publisher
- Wiley
- Published
- 2011-10
- Volume
- 53
- Issue
- 4
- Pages
- 435-439
- ISSN
- 0277-2116 (ISSN-L)
- 1536-4801
- PMC
- PMC3674887
- OpenAlex
- W183434716
- Cited by
- 45
- References
- 18
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 4 · 2017: 8 · 2016: 2 · 2015: 5 · 2014: 2 · 2013: 5 · 2012: 1
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Pediatric Gastroenterology and Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Presbyterian Historical Society (P30 DK 078392, NIDDK K23 DK079037)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- medication non-adherence, pediatric inflammatory bowel disease, adolescents, 6-mercaptopurine, azathioprine, 5-aminosalicylic acid, treatment feasibility, acceptability, pill count
- MeSH terms
- Adolescent, Azathioprine, Child, Feasibility Studies, Female, Humans, Interviews as Topic, Male, Patient Education as Topic, Pilot Projects, Surveys and Questionnaires, Mercaptopurine, Inflammatory Bowel Diseases, Treatment Outcome, Mesalamine, Medication Adherence, Precision Medicine
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