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Improving adherence in paediatric respiratory disease

Ted Klok, Adrian A. Kaptein, Paul L.P. Brand
Breathe 2013 9: 268-277; DOI: 10.1183/20734735.002513
Ted Klok
1Princess Amalia Children's Clinic, Isala Klinieken, Zwolle
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Adrian A. Kaptein
2Unit of Psychology, Leiden University Medical Centre, Leiden
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Paul L.P. Brand
1Princess Amalia Children's Clinic, Isala Klinieken, Zwolle
3UMCG Postgraduate School of Medicine, University Medical Center and Groningen University, Groningen, The Netherlands
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  • For correspondence: p.l.p.brand@isala.nl
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  • Figure 1
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    Figure 1

    Electronic adherence monitoring devices suitable for use in clinical practice and research. a) Doser, b) MDILog, c) Smartinhaler and d) SmartDisk.

  • Figure 2
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    Figure 2

    Horne's extension of the common sense model, showing the relationship between illness perceptions, medication beliefs, and adherence. Reproduced from [3] with permission from the publisher.

Tables

  • Figures
  • Barriers to adherence
    Treatment-related barriersClinician-related barriersPatient-related barriers
    Complex treatment scheduleDifficulties in scheduling appointmentsPoor understanding of disease or treatment
    Lack of an immediately discernible beneficial effectLack of empathy and interest from clinicianLack of trust in healthcare professionals
    Adverse effectsRotating physiciansPsychological problems or psychiatric illness
    Cost, reimbursement problemsPhysician provides information, but leaves little room for questions and concernsSocial issues (poverty, lack of healthcare insurance, lack of family (medication taking) routines)
    Illness perceptions and medication beliefs hampering motivation to adhere
  • The five E’s of Ensuring optimal adherence
    Ensure follow-up
     See patients and their parents repeatedly
     Helps to build trust and partnership
    Explore patient's views, beliefs and preferences
     Explore illness perceptions and medication beliefs
     Examine patient's context, views, and preferences
     Discuss potential barriers to adherence (see barriers to adherence box)
     Invite questions, comments, remarks
    Express Empathy
     Positive, caring attitude
     Use active listening techniques
     Provide information tailored to patient's needs
    Exercise shared decision making
     Aim for concordance (see definitions box)
     Take patient's views and preferences into account
     Agree on treatment and action plan with patient
    Evaluate
     During follow-up visits: evaluate success of treatment
     Discuss adherence in non-judgmental fashion
     Offer help when needed to overcome barriers
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Vol 9 Issue 4 Table of Contents
Breathe: 9 (4)
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Improving adherence in paediatric respiratory disease
Ted Klok, Adrian A. Kaptein, Paul L.P. Brand
Breathe Jun 2013, 9 (4) 268-277; DOI: 10.1183/20734735.002513

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Improving adherence in paediatric respiratory disease
Ted Klok, Adrian A. Kaptein, Paul L.P. Brand
Breathe Jun 2013, 9 (4) 268-277; DOI: 10.1183/20734735.002513
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Jump To

  • Article
    • Abstract
    • Introduction
    • Terminology
    • Nonadherence: is it relevant?
    • Nonadherence: the scope of the problem
    • Measuring adherence
    • A useful model to understand medication taking behaviour
    • Barriers to adherence
    • What can the healthcare professional do to improve adherence?
    • Principles of improving adherence in paediatric chronic conditions
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Subjects

  • Paediatric pulmonology
  • Respiratory clinical practice
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More in this TOC Section

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  • e-Learning for the medical team
  • The problems of cohort studies
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