Investigation On The Medication Adherence And Influencing Factors Of Children Who Took Long-term Oral Glucocorticoids

Background:Glucocorticoids have been the most widely used antibiotics and immunosuppressive drugs in clinical practice.Long-term use of glucocorticoids is still the mainstay of treatment in some pediatric chronic diseases,for example,the systemic lupus erythematosus(SLE),nephrotic syndrome,systemic vasculitis and so on.Some children even need to use glucocorticoids in their lifetime.Therefore keeping good medication compliance is crucial to manage diseases and improve the prognosis.Unfortunately glucocorticoids are very different from other common medicines,causing important adverse effects(AEs),especially in the pediatric age group.For children with chronic diseases,their cognitive function is immature and self-management ability is poor,so the characteristics of medicine usage are different from adults'.As pediatric patients age into adolescence,there is an expected shift in the burden of responsibility,including medication management,from parents to adolescents.But most of the time they are unprepared to make this transition because of the specialty of this period.According to many researches,adolescence is a risk factor for poor medical adherence.So we should pay more attention to these adolescents in case of non-adherence to medications,which is one of the leading causes of acute relapse of chronic illnesses.Recently,most of the investigations of medication adherence of glucocorticoids focused on adults and children with asthma and there is still no examination about long-term usage of oral glucocorticoids in children.Objective:To describe the medication adherence level of long-term usage of oral glucocorticoids of children with chronic illness and explore the influencing factors of medication adherence.Methods:A cross-sectional survey of 181 children and their parents was conducted in pediatric outpatient and ward department in Peking Union Medical College Hospital.Convenient sampling was adopted.All of the pediatric patients have already taken glucocorticoids for more than three months.The medication adherence was measured by the medication adherence questionnaire.And the influencing factors were investigated by a series of instruments,like the General information questionnaire,Beliefs about Medicine Questionnaire,General Self-Efficacy Scale,Medication knowledge questionnaire,and so on.Binary logistic regressions were used to determine the influencing factors of medication adherence.Semi-structured individual interviews were used to further explore the influence factors of adherence.Results:1.The average score of medication adherence was 14.88±1.65(the total score is 16),which is relatively high.But the complete adherence rate was only 46.4%.The adherence rates of four dimensions from high to low were proper dosage(90.1%),right frequency(87.8%),long-term adherence(84.0%)and being on time(58.0%).Parents-reported score of medication adherence was 15.04± 1.34,there was no significantly difference in compliance level between children and parents,and there were significant correlation between children report's average score/compliance rate and parents report's(r=0.567,P<0.001;r=0.611,P<0.001).2.Binary logistic regression results showed that the main influencing factors were the time since onset of oral glucocorticoids,the participation of adolescents,children's knowledge of glucocorticoids,and their perceived family support,which explained 23.7%of the variance of medication adherence.Adolescents who used glucocorticoids for shorter time,took responsibilities in medication,and with higher level of medicine knowledge and perceived more family support,had the better adherence.3.Semi-structured interviews results revealed that there were still some promoting factors of medication adherence.Being worry about the AEs,but they have no choose;Believe in doctors and absolutely obey doctors' words;Not dare to reduce or stop taking medicine in case of disease aggravating or relapses;And the parents still played important role in the medication progress.Conclusion:The level of long-term oral glucocorticoids adherence in children with chronic illnesses is not high,especially in the aspect of taking medicine on time.To encourage children to participate in medication,provide health education and family support for them may improve medication adherence.