Pediatric Adherence and Young Investigators: Interesting Questions, Perhaps a Path to Some Answers

Pediatric Adherence and Young Investigators: Interesting Questions, Perhaps a Path to Some Answers

10.01.12 | By

Speaking as a father of three little ones, I can appreciate a parent's reluctance to medicate a child. Yes our pediatrician recommended the medicine, but is it really necessary? What about drug resistance over time? How about we give her just half a dose?

Such questions inevitably flow through mind of a parent and are discussed with a spouse.

Now, I know we've made huge strides in recent years in the research and development of medicines for children - partly reflecting the positive impact of the Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA).

I'm also aware of the health risks (and economic consequences) of not adhering to prescribed medications. But until now, I hadn't really given much thought to the merged topic of adherence among children.

A new study published last week in Pediatrics hits on this very topic, offering food for thought from a public health standpoint, as well as from the perspective of a parent. A Reuters article nicely captured the gist of the study.

To identify the proportion of unfilled prescriptions in a pediatric primary care setting, a team of researchers studied Medicaid claims data for 4,833 children seen over a two-year period at two clinics affiliated with the Lurie Children's Hospital of Chicago.

Among their conclusions, the researchers found that "primary nonadherence (failure to fill a prescription) occurs in more than 20% of prescriptions given at primary care visits."

The team observed significant variation of adherence within eight categories of medications, with fill rate highest among oral anti-infectives and lowest with nutritional supplements and gastrointestinal medications. This seems intuitive - after all, we want to protect our children from the most imminent and scary threats to their health.

They then discuss both clinical and demographic factors that can impact prescription filling, pointing to e-prescribing as one way of potentially increasing adherence.

We know that improved adherence to prescribed medicines can lead to better health outcomes and can help control health care costs. But it's a sticky wicket, with no simple solution. And it's safe to say the stickiness of the wicket is even greater when we're talking about children.

The Pediatrics research team says that "[f]uture studies should be designed to clarify barriers to prescription filling and to develop and test interventions intended to improve primary adherence."

To this end, the PhRMA Foundation recently announced a new Center for Adherence Improvement - Young Investigator Grant Program to help spur new research on the topic. The new program encompasses pre-doctoral and post-doctoral fellowship awards and research starter grants; deadline for submissions is Oct. 30.

Will the PhRMA Foundation's program answer all of these difficult questions? No, of course not. But it's a nice step in the right direction.

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