P04 Barriers and facilitators to medicines adherence in children: a systematic review
Bibliographic record
Abstract
Aim Improving adherence to medicines in children with chronic conditions may lead to significant economic and health benefits. 1 To improve adherence, the multifactorial causes of poor adherence should be understood. 1 A systematic review for barriers and facilitators to medicines adherence in children was conducted seven years ago. 2 We updated this to identify barriers and facilitators to medicines adherence in children reported in the last ten years. Method A systematic literature search was performed using PubMed, EMBASE, Medline, CINAHL, IPA and Cochrane library databases covering the period November 2008 to March 2019. Inclusion criteria were original research studies identifying barriers and/or facilitators of medicines adherence in children (aged 0–18 years) and included all countries and languages. Exclusion criteria included review articles, editorials, conference papers, reports and studies in adults only. As a reliability measure, 5% of titles and abstracts were assessed independently by a second researcher. Quality assessment was performed on all included studies using the STROBE checklist for observational studies and Cochrane collaboration tools for randomised controlled studies and was checked by a second researcher. Results Of 9,360 papers identified by the search, only 172 articles met the inclusion criteria. Most studies were conducted in the US (76), with 11 in the UK, six in Canada and the remaining 79 studies in various countries. Diseases studied included: HIV/AIDS (60), asthma (25), kidney or liver diseases and transplants (18), psychiatric disorders (12), inflammatory bowel disease (10), epilepsy (9) and others (38). Various tools were used to identify barriers and facilitators to medicines adherence. These included 131 studies which used individually designed questionnaires, 32 studies used validated questionnaires and the remaining 9 studies used patients’ medical data. Forgetfulness and fear of side effects were the most common reported barriers to medicines adherence. Others reported barriers to adherence included family conflict, weak patient-provider relationships, stigma and discrimination, drug regimen complexity and lack of support from families. Factors reported to facilitate high rates of adherence included the linking of medicine taking with daily life routines, using reminders to avoid forgetfulness, a higher level of caregivers and parental education and good communication between healthcare professionals, patients and parents. Conclusion The main findings of this systematic review show that children faced many and varied barriers to medicines adherence with different diseases. Using reminders to avoid forgetfulness and good communication between healthcare professionals, patients and parents were the most common facilitators. To achieve optimal adherence, healthcare providers need to be aware of these barriers and to consider the most appropriate facilitators to encourage patients to take their medicines as prescribed. References Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011; 86 :304–14. Elliott RA, Watmough DE, Gray NJ, Conroy S, Lakhanpaul M, Pandya H, et al . Talking about medicines (TABS): a multi-method study to understand reasons for medicines non-adherence in children and young people with chronic illness, and to improve their contribution to managing their medicines. Natl Inst Heal Res 2012; 1–423.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".