Abstract
Nonadherence in children who use long-term medication is a serious problem and assessing adherence is an important step to provide solutions to this problem. Medication adherence can be measured by several methods, including (a) self-report questionnaires or structured interviews, (b) therapeutic drug monitoring (TDM), (c) electronic devices, and (d) pick-up/refill rates. The objective of this narrative review is to provide an overview of the literature about methods for the measurement of medication adherence in chronically ill children and adolescents. Therefore, we conducted a literature search by using multiple databases. Four methods of monitoring medication adherence are presented for the most described chronic diseases: asthma, HIV/AIDS, epilepsy, diabetes mellitus and ADHD. First, 10 commonly used self-report questionnaires and structured interviews are described, including the main characteristics, (dis)advantages and their validation studies. Second, the use of TDM in pediatric trials for medication adherence measurement is discussed. New sampling methods (e.g. dried blood spot) and sampling matrices (e.g. hair, saliva and urine) have shown their benefits for TDM in children. Third, electronic devices to measure medication adherence in children are presented, being developed for several drug administration routes. Fourth, the analyses, advantages and disadvantages of pharmacy data are discussed. The usage of this data requires specific calculations and interpretations to assess adherence. As presented in this review, every adherence method has specific (dis)advantages. When deciding which adherence method is applicable, validity and generalizability should be taken into account. Combining multiple methods seems to offer the best solution in the daily clinical practice.
Key points
What is known:
Medication adherence can be measured by several methods: self-report questionnaires (structured interviews), TDM, electronic devices and pick-up/refill rates. It is recommended to assess adherence by combining multiple adherence methods, while keeping their individual (dis)advantages in mind.
What is new:
To provide a comprehensive and updated narrative review of the existing literature concerning measurement methods of medication adherence in children and adolescents with a chronic illness.
The review focuses on the usage of these methods in pediatric populations with common chronic conditions: asthma, HIV/AIDS, epilepsy, diabetes mellitus and ADHD. With this overview, we aim to provide clinicians the tools to make the right decision when assessing adherence in the daily clinical practice.
Disclosure
The authors report no conflicts of interest in this work.