Got Meds: Drug Adherence for Young People with Chronic Medical Conditions
By Santi KM Bhagat, MD, MPH | Friday, October 30th, 2009
If medication adherence is a problem for adults, consider how difficult it is for young people with chronic medical conditions.
Alternate flavorings, formulations, and suspensions can help the medicine go down in children. But what is the solution when taste is not the problem? One approach we need to take is to put the young person center and first. Talking past the child to the parents is a practice that continues today and even with many young adults patients. If we want young people to succeed in self-medication management, they must be the drivers of their care.
Child-centered care:
Psychoeducation: As soon as the child is able to participate, he needs to be educated about his condition and medication regimen so he understands what his happening to his body. Participating in the decision-making process, e.g., whether to take the morning medicine after brushing teeth or at breakfast, protects the child’s autonomy and sense of control.
Contracts help in getting the young person to take ownership, and patient records are an age-old but effective method of monitoring adherence. Children can check boxes on printed forms, manually or computerized; parents can help by incentivizing adherence with tokens or rewards. Encouraging the child to share the record in the next medical visit further increases his autonomy – a critical issue when one loses the sense of control over one’s body. Physician follow-up is critical to promoting adherence, e.g., counting pills, checking records.
Communication skills and understanding the young person’s perspective are key ingredients to building trust. A non-judgmental attitude along with a willingness to negotiate and temporarily modify medications can help a young person understand the need to adhere to a regimen.
Problems may surface when the child enters adolescence and considers engaging in risk-taking behaviors. This is also the time to foster health self-management and start the transition process to adult-oriented health care. As the teen matures, he must be educated and encouraged to learn about his condition and management. The physician should work with the family to develop a step-wise approach to increase responsibility, e.g., first succeed at level 1 for x months before moving up to level to 2. For example:
- Monitor patient-recorded adherence chart
- Make doctor’s appointments and record on chart (physician visits are associated with adherence)
- Order prescriptions and record on chart
- Fill medication trays








