Improving medication adherence in children

with CF – what a pharmacist can do

Nanna Christiansen, Lead Clinical Pharmacist – Paediatrics, Barts Health NHS Trust

Jaimini Gohil, Suzanne Bishop, Nanna Christiansen

Improving medication adherencein children with CF – What a pharmacist can do?

Background to Cystic Fibrosis

Medical management requires wide range of medication:

- digestive enzymes- vitamins and supplements- bronchodilators- mucolytics- inhaled, PO or IV antibiotics- anti-reflux- insulin

• Adherence differs depending on – Complexity and number of medicines– Palatability– Immediate effect associated with intake– Duration of treatment– Time needed to take the medication– Patient factors

• Adherence rate around 50% can be expected for CF

Adherence – what we know

• Explore factors affecting medication adherence in paediatric CF patients

• Obtain patients’ opinion on pharmacist led interventions to help with adherence

Aims

Methodology

• Cross sectional study• Data collection using self-reported questionnaire• Inclusion criteria:

• Between 11 to 16 years• Confirmed diagnosis of CF• Able to read and understand English• Able to fill in the questionnaire themselves

• Exclusion criteria:• Children in terminal phase of illness

Questionnaire

• Section A – Demographics

• Section B– Adherence to different medication– Children's perception of necessity of medication– Reasons for non-adherence

• Section C– Assessment of pharmacist led interventions

Results• 17 eligible patients, 12 took part

Pancreatic enzymes

•9 (81.8%) - necessary

•2 (18.2%) – not necessary

Helps me digest my

food

Helps my tummy aches

I don’t notice a differenc

e

63.6%

18.2%9.1% 9.1%

Vitamins & supplements

•6 (50%) - necessary

•4 (33%) – not necessary

Helps me grow

Makes me

vomit

Don’t see how it helps

Can’t see how it

makes a difference

8.3%16.6%16.6%

58.3%

Inhaled medications

• 11 children on inhaled medication

• 64% (7) adherent, 36% (4) partially adherent

•73% (8) - necessary

•27% (3) – not necessary

I don’t see a

difference

I feel better

It liquefies

my mucus

Helps me clear

bugs

Makes me breath

better

Factors affecting adherenceSimply forgot: 41.7% - 58.3% Don’t like the taste – 16.7%

Don’t want my friends to know 8.3% Not important – 8.3%

Pharmacist led interventions

• Interventions described in literature: • Written (PIL) and oral communication (counselling)• Telephone based follow up • Reminder charts• Pill boxes

58.3%

16.7%25%

Medication information provision

New medication – 67% receive information from doctor- 33% have not been given information

Pharmacist at clinic – 50% ‘would not make a difference’ - 50% ‘would help in providing information on CF meds’

At home

25%

41.7%33.3%

Conclusion

• Reported adherence levels slightly higher than in literature

• Unique information on children’s perception and preferred interventions

In practice:• Useful information for pharmacist in clinic • Child friendly drug information provision

References

• Bucks RS, Hawkins K, Skinner TC et al. Adherence to treatment in adolescents with cystic fibrosis: the role of illness perceptions and treatment beliefs. J Pediatr Psychol, 2009;34:893-902

• Haynes RB, Ackloo E, Sahota N et al. Interventions for enhancing medication adherence. Cochrane DatabaseSystRev.2008Apr16;(2):CD000011.doi:10.1002/14651858.CD000011.pub3.

• Modi AC, Lim CS, Yu N et al. A multi-method assessment of treatment adherence for children with cystic fibrosis. Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society, 2006; 5:177-185.

• Segal TY Adolescence: what the cystic fibrosis team needs to know. J r Soc Med, 2008;101:15-27

• Quittner AL, Espelage DL, Ievers-Landis C, Drotar D. Measuring adherence to medical treatments in childhood chronic illness: Considering multiple methods and sources of information. Journal of Clinical Psychology in Medical Settings, 7, 41-54.