Perceived barriers to medication adherence in pediatric and adolescent solid organ transplantation

Abstract

Comparisons of perceived barriers to adherence in pediatric and adolescent SOT have not been systematically conducted despite association between medication non-adherence and poor outcome. Fifteen centers in CTOT-C enrolled patients in a cross-sectional study. Subjects' guardians completed the PMBS and subjects over eight completed the Adolescent Scale (AMBS). Association of three identified PMBS factors and subject age was assessed. Secondary analyses assessed associations between PMBS, AMBS, and patient demographics. Three hundred sixty-eight subjects or their guardians completed PMBS or AMBS. A total of 107 subjects were 6-11 yr; 261 were ≥12. Unadjusted and propensity-adjusted analyses indicated higher perceived barriers in guardians of adolescents as compared to guardians of pre-adolescents medication scheduling and frustration domains regardless of organ (p < 0.05). PMBS and AMBS comparisons revealed that guardians reported fewer ingestion issues than patients (p = 0.018), and differences appeared more pronounced within younger responders for scheduling (p = 0.025) and frustration (p = 0.019). Screening revealed guardians of older patients report increased perceived barriers to adherence independent of socioeconomic status. Guardians of adolescents reported fewer perceived barriers to ingestion/side effects than patients themselves, particularly in pre-adolescents (8-11 yr). Brief screening measures to assess perceived barriers should be further studied in adherence improvement programs.

Keywords: adherence; pediatric; solid-organ transplant.

Figure 1

CTOTC-05 Cross-sectional Study Participant Flow

Figure 2.

Each PMBS item is rated on a 5-point scale from 1 (strongly disagree, low barrier) to 5 (strongly agree, high barrier). Factor scores are presented as the mean of the factor item ratings. Boxplots represent the inner quartile range of the data, with the median indicated by the center line, whiskers extending up to 1.5 times the length of the box, and outliers represented by an open circle. The mean for each age-organ group is represented by a solid colored circle, with colored lines connecting the means of the two age groups for the same organ.