Managing Very Poor Adherence to Medication in Children and Adolescents: An Inpatient Intervention

Abstract

Poor adherence with medical care is a relatively common problem in pediatric patients, with potentially serious side-effects. This article describes a four-phase inpatient intervention program for such cases. Patients are first identified and admitted to the unit: careful preparation is essential in this phase. In the assessment phase, factors related to the illness and treatment regimen, as well as characteristics of the individual child and family, are evaluated to determine their contributions to the adherence problem. In the third phase, an intervention program is implemented, consisting of: (i) education of the patient and family regarding the illness and medical regimen; (ii) improvement of self-management skills; (iii) behavioral intervention using contingent reinforcement; and (iv) treatment of additional barriers to adherence such as psychopathology and family dynamics. The fourth phase focuses on transfer of care to home through gradually increasing the patient’s and family’s responsibility for care.