Examining Parental Medication Adherence as a Predictor of Child Medication Adherence in Pediatric Anxiety Disorders

Dados Bibliográficos

ID9104960
AutoresGreta A Bushnell (Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health), Greta Bushnell (0000-0002-4056-8405, University of North Carolina at Chapel Hill, autor correspondente), M Alan Brookhart (0000-0003-1572-0564, Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, autor correspondente), Bradley N Gaynes (0000-0002-8283-5030, Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill), Scott N Compton (0000-0003-2887-9582, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham), Stacie B Dusetzina (0000-0002-3907-9196, Department of Health Policy, School of Medicine, Vanderbilt University Medical Center, Nashville, TN), Til Stürmer (0000-0002-9204-7177, Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, autor correspondente)
Ano2018
Volume56
Fascículo6
Páginas510-519
Data de publicação2018-06-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000911
PMID29668649
OpenAlexW2801313514
IdiomaEN
Citações recebidas1
Referências citadas49

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety disorders but adherence remains difficult to predict. OBJECTIVES: To estimate SSRI adherence in children with anxiety disorders and determine if prior parental medication adherence is predictive of child high SSRI adherence. METHODS: We identified children (3-17 y) initiating SSRI treatment after an anxiety disorder diagnosis in a commercial claims database (2005-2014). We evaluated parent SSRI, statin, and antihypertensive adherence [6-mo proportion days covered (PDC), high adherence=PDC≥0.80] in the year before child SSRI initiation. We estimated risk differences (RD) of child high SSRI adherence (6-mo PDC) stratified by parent adherence and multivariable risk ratios using modified Poisson regression. We estimated change in c-statistic and risk reclassification when adding parent-level covariates with child-level covariates to predict child adherence. RESULTS: In 70,979 children with an anxiety disorder (59%=female, 14=median age), the mean 6-month SSRI PDC was 0.72, with variation by anxiety disorder. Overall 64% of children had high adherence if their parent had high SSRI adherence versus 53% of children with parents with low SSRI adherence (RD, 12%; multivariable risk ratios, 1.17; 95% confidence interval, 1.14-1.20). Findings were similar for parent statin (RD=10%) and antihypertensive adherence (RD=8%) and when stratified by child age and parent sex. There was minor improvement in risk reclassification and the c-statistic after adding parent adherence and parent-level covariates. CONCLUSIONS: Parental medication adherence could help providers identify children at risk of nonadherence to inform the treatment decision, reduce unnecessary medication switches, and lead to broader effective interventions

Anxiety · Anxiety disorder · Confidence interval · Odds ratio · Poisson regression · Population · Psychiatry · Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes · Attention Deficit Hyperactivity Disorder · Child and Adolescent Psychosocial and Emotional Development · Clinical Psychology · Internal Medicine · Medicine