Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.
Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
Can J Gastroenterol Hepatol. 2020 Feb 25;2020:9562192. doi: 10.1155/2020/9562192. eCollection 2020.
Measurement of the degree of adherence is a key element for the evaluation of treatment efficacy and safety; thus, adherence plays an important role in clinical research and practice. The aim of this study was to investigate medication adherence in children with inflammatory bowel disease (IBD) utilizing a multimethod assessment approach. A further aim was to examine factors that can influence adherence within this population.
Medication adherence in 47 children (age range 3 to 17 years) with IBD in three centers in Northern Ireland and Jordan was assessed via subjective (parent and child versions of the Medication Adherence Report Scale (MARS) specific questionnaire) and objective methods, that is, high-performance liquid chromatography (HPLC) determination of the 6-mercaptopurine (6-MP) and azathioprine (AZA) metabolites in packed red blood cell samples taken during a clinic visit. Beliefs about prescribed medicines were also assessed in parents/guardians using the Beliefs about Medicines Questionnaire (BMQ).
An overall nonadherence to AZA/6-MP therapy in children with IBD was found to be 36.17% (17 out of 47 patients were classified as nonadherent using at least one of the assessment methods). A total of 41 patients (91.1%) were classified as adherent to AZA or 6-MP using the blood sampling, while adherence rates using the MARS questionnaire completed by children and parents/guardians were 60.6% and 72.7%, respectively. The latter provides a more longitudinal measure of adherence. Child self-reported nonadherence rates were significantly higher than parent/guardian reported rates (=0.013). Binary logistic regression analysis identified age to be independently predictive of adherence, with adolescents (children aged ≥ 13 years old) more likely to be classified as nonadherent. Regarding the BMQ, when parental/guardian necessity beliefs outweighed concerns, that is, higher scores in the necessity-concern differential (NCD), adolescents were more likely to be classified as adherent.
Results provide evidence for ongoing adherence challenges in the paediatric population with IBD. It is recommended that parents/guardians (particularly of older children) and older children themselves, should receive enhanced counselling and education about their prescribed medicines.
衡量治疗的依从性是评估治疗效果和安全性的关键要素；因此，依从性在临床研究和实践中起着重要作用。本研究旨在利用多方法评估方法调查炎症性肠病（IBD）儿童的药物依从性。另一个目的是研究影响该人群依从性的因素。
在北爱尔兰和约旦的三个中心，通过主观（家长和儿童版用药依从性报告量表（MARS）特定问卷）和客观方法评估 47 名 IBD 儿童（年龄 3 至 17 岁）的药物依从性，即通过高效液相色谱法（HPLC）测定在就诊期间采集的红细胞样本中的 6-巯基嘌呤（6-MP）和硫唑嘌呤（AZA）代谢物。还使用药物信念问卷（BMQ）评估了家长/监护人对规定药物的信念。
发现 IBD 儿童总体上存在 AZA/6-MP 治疗不依从，不依从率为 36.17%（47 名患者中至少有 17 名患者使用至少一种评估方法被归类为不依从）。共有 41 名患者（91.1%）使用血液样本被归类为 AZA 或 6-MP 依从，而儿童和家长/监护人完成的 MARS 问卷的依从率分别为 60.6%和 72.7%。后者提供了更纵向的依从性衡量标准。儿童自我报告的不依从率明显高于家长/监护人报告的率（=0.013）。二元逻辑回归分析确定年龄是独立预测依从性的因素，青少年（年龄≥13 岁）更有可能被归类为不依从。关于 BMQ，当父母/监护人的必要性信念超过担忧时，即必要性-关注差异（NCD）的分数较高，青少年更有可能被归类为依从。
结果为儿科 IBD 人群中持续存在的依从性挑战提供了证据。建议家长/监护人（特别是年龄较大的儿童）和年龄较大的儿童本身应接受关于其规定药物的强化咨询和教育。
