Adherence to Pediatric Medical Regimens (eBook)

Michael Rapoff received his PhD in Developmental and Child Psychology in 1980 from the University of Kansas and completed a two year post-doctoral internship in Behavioral Pediatrics at the University of Kansas Medical Center. Dr. Rapoff is currently Ralph L. Smith Professor of Pediatrics and Chief of the Behavioral Pediatrics division in the Department of Pediatrics at the University of Kansas Medical Center. Dr. Rapoff is a Fellow of the American Psychological Association, is a licensed psychologist in Kansas and Missouri, and is listed in the National Registry of Health Service Providers in Psychology. His research interests during the past 26 years has focused on psychosocial issues affecting children and adolescents with chronic diseases, including adherence to medical regimens, pain, and psychosocial adjustment.He has been funded by NIH and Maternal and Child Health to evaluate strategies for improving adherence to medical regimens for children with asthma and juvenile rheumatoid arthritis (JRA) and by the Arthritis Foundation for evaluating a cognitive-behavioral pain management program for children and adolescents with JRA. Dr. Rapoff has 73 publications in journals or books, including a single-authored book published in 1999 on pediatric medical adherence (Adherence to Pediatric Medical Regimens, Kluwer/Plenum). In 2003, Dr. Rapoff received the Distinguished Scholar Award from the Association of Rheumatology Health Professionals, a division of the American College of Rheumatology, in recognition of outstanding rheumatology scholarship. Also in 2003, Dr. Rapoff was elected as a Fellow in the Society of Pediatric Psychology, Division 54 of the American Psychological Association.Dr. Rapoff is currently funded by NIH to evaluate the efficacy of a computer-based CD-ROM program (Headstrong) for treating chronic headaches in children. In addition to his research, Dr. Rapoff trains clinical psychology students in health psychology and pediatric psychology and teaches residents and medical students. He also sees patients once per week in his Behavioral Pediatrics Outreach Clinic in Lawrence, KS.

Issues in Clinical Child Psychology 1
Preface 5
Contents 7
1 Definitions of Adherence, Types of Adherence Problems, and Adherence Rates 11
Definitions 11
Types of Adherence Problems 13
Adherence Rates to Acute and Chronic Disease Regimens 14
Adherence to Acute Disease Regimens 14
Adherence to Chronic Disease Regimens 17
2 Consequences of Nonadherence and Correlates of Adherence 42
Consequences of Nonadherence 42
Health and Well-Being Effects 42
Cost-Effectiveness of Medical Care 43
Clinical Decisions 44
Clinical Trials 44
Correlates of Adherence to Medical Regimens 45
Patient/Family Correlates 46
Disease-Related Correlates 49
Regimen-Related Correlates 50
Correlational Cautions and Risk Profile for Nonadherence 51
Clinical Implications Related to Adherence Correlates 52
3 Adherence Theories: Review, Critique,and Clinical Implications 55
The Health Belief Model 56
Description 56
Critical Appraisal 56
Clinical Implications of the HBM 58
Social Cognitive Theory (Self-Efficacy) 59
Description 59
Critical Appraisal 60
Clinical Implications of SCT (Self-Efficacy) 62
The Theory of Reasoned Action/Planned Behavior 63
Description 63
Critical Appraisal 65
Clinical Implications of the TRA/PB 65
Transtheoretical Model 66
Description 66
Critical Appraisal 67
Clinical Implications of the TTM 69
Applied Behavior Analytic Theory 71
Description 71
Critical Appraisal 73
Clinical Implications of ABA Theory 74
Summary and Implications of Adherence Theories 75
4 Measurement Issues: Assessing Adherence and Disease and Health Outcomes 77
Why Assess Adherence? 77
Screening and Diagnosis 77
Prediction 78
Intervention Selection 78
Evaluation of Intervention Efforts 79
What Is to Be Assessed? Selection of Target Behaviors 79
Guidelines for Selecting Target Regimen Behaviors 79
Who Should Be Assessed and Who Should Assess? 81
How to Assess Adherence? A Critical Review of Assessment Strategies 81
Drug Assays 82
Observation 85
Electronic Monitors 87
Pill Counts 91
Provider Estimates 92
Patient/Parental Reports 94
Comparative Performance of Adherence Measures 102
Generic Methodological Issues and Recommendations for Adherence Measurement 110
Reactivity 110
Representativeness 110
Directness 111
Measurement Standards 111
Interpretation or What's in a Number? 112
Clinical and Treatment Utility 113
Assessing Disease and Health Outcomes 114
Methodological Issues and Recommendations for Disease and Health Measures 116
Choice of Informants 116
Representativeness 116
Generic vs. Disease-Specific Measures 117
Psychometric Standards 118
Limiting ''Physiogenic Bias'' 118
Clinical Feasibility, Utility, and Relevance 119
Conclusions 120
5 Strategies for Improving Adherence to Pediatric MedicalRegimens 122
Educational Strategies for Improving Adherence 123
The ''Why?'' or Goals of Education 123
The ''What?'' or Specific Objectives and Content of Education 123
The ''How?'' of Educational Strategies 124
Summary of Educational Strategies 127
Organizational Strategies for Improving Adherence 128
Increasing Accessibility to Health Care 128
Consumer-Friendly Clinical Settings 128
Increasing Provider Supervision 129
Simplifying and Minimizing Negative Side Effects of Regimens 130
Summary of Organizational Strategies 132
Behavioral Strategies for Improving Adherence 134
Parental Monitoring and Supervision 134
Prompting Adherence 136
Adherence Incentives 136
Discipline Strategies 142
Self-Management Strategies 144
Psychotherapeutic Interventions 145
Summary of Behavioral Strategies 147
Individualizing Interventions: Barriers to Adherence and Functional Analysis 147
Barriers to Adherence 147
Functional Analysis 148
Technology-Based Interventions 150
Conclusions 152
6 Review of Adherence Intervention Studies and Top Ten Ways to Advance Research on Adherence to Pediatric Medical Regimens 153
Intervention Studies on Improving Adherence to Regimens for Acute Pediatric Diseases 153
Intervention Studies on Improving Adherence to Regimens for Chronic Pediatric Diseases 157
Meta-Analytic Reviews of Adherence Interventions for Pediatric Medical Regimens 158
Meta-Analyses of Adherence Interventions for Adults 158
Meta-Analysis of Adherence Interventions for Acute Pediatric Diseases 183
Meta-Analyses of Adherence Interventions for Chronic Pediatric Diseases 183
Conclusions from the Meta-Analyses 186
Top Ten Ways to Advance Pediatric Medical Adherence Research (With Apologies to My Colleagues Who Have Heard Me Present This at Two Different National Meetings) 187
The Inflated Importance of Adherence 190
References 192
Index 218