Date of Graduation

2001

Document Type

Dissertation/Thesis

Abstract

Nonadherence to asthma medication is a persistent problem. Contingency management has been used to improve pediatric compliance to inhaled corticosteroids. But token systems require time and attention to design and maintain, creating a challenge for busy outpatient clinics. The purpose of the present study was to evaluate the effectiveness of an intervention that might more easily be implemented by medical staff and parents: objective monitoring of medication use and feedback regarding errors in technique and compliance as an intervention to improve children's adherence to inhaled corticosteroids. Pediatric patients diagnosed with bronchial asthma for at least 6 months, receiving long-term corticosteroid treatment for disease management, and considered “nonadherent” by their pediatric allergists were recruited for the study. Using a nonconcurrent multiple-baseline design, patients and their parents received bi-weekly feedback regarding their medication compliance, following an initial baseline phase. Data regarding aspects of patient inhaler use were collected with an electronic recording device attached to each patient's inhaler. Medical staff also reviewed appropriate technique when indicated. Following the treatment condition, the feedback component was withdrawn and the effects of monitoring alone were observed on patient adherence. Outcome measures included changes in adherence rates and inhaler technique, pulmonary lung function, functional severity of illness, and treatment satisfaction. Overall, results showed improvements in adherence rates following the treatment phase, particularly for patients whose baseline-rate of inhaler use was low. Improvements in technique were more evident and consistent across patients; lung function changes tended to correlate with levels of medication use. During the monitoring alone condition (when the feedback component was withdrawn), compliance behavior tended to decrease, but technique improvements maintained. These outcomes suggest that such an intervention may have clinical utility in improving children's adherence to asthma medications.

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