Medication Adherence among Adolescents in a School-Based Health Center

Article excerpt

School-based clinics have become an important model for national efforts to overcome health care access barriers for adolescents. (1) School-based health centers can increase students' health knowledge and access to health-related services, especially for adolescents in greatest need. (1,2) Yet, many adolescents face additional obstacles to receiving high-quality health care that include family poverty, lack of health insurance, language barriers, confidentiality, transportation issues, and having a parent who is unable to take time from work to attend to their child's medical and dental care needs. (1) While school-based health centers have alleviated some of these barriers, for example, by offering free health services, challenges persist in providing optimal health care to young adolescents in a school-based setting. This study focuses on understanding the challenges, for a student who has received a prescription in a school-based clinic, in getting the prescription filled and in taking the medication properly.

A critical first step to studying medication adherence is assessing whether the patient filled the prescription. While most studies have focused on adult patients, 2 studies included children and found that prescriptions for medications for chronic illnesses (3) and for younger patients (4) were more likely to be filled.

More than 1.5 billion prescription drugs are dispensed each year, and it has been suggested that approximately 50% of patients fail to take their medication as prescribed. (5) With regard to adolescents, several studies have assessed adolescents with asthma and found that rates for nonadherence with medication ranged from 17% to 90%. (6-9) While studies have reported on barriers to medication adherence, in particular with regard to birth control (10) and AIDS, (11) and identified predictors of adherence with medications in adolescents with a chronic disease, (12) no studies have focused on young adolescents receiving prescriptions in school-based clinics or on other barriers to adherence in this setting.

Intentional nonadherence is a significant problem among adult patients, particularly among patients who have chronic disorders such as asthma, hypertension, HIV, and diabetes. (5) Unintentional nonadherence has not been extensively studied. For adolescents who have not reached adult thinking and responsibility, this may be a significant problem. (13-16) The assessment of adolescent females' own past adherence with medication was found to be useful in predicting their future adherence with contraception. (17) The literature also suggests that, for adults, medication adherence may be a "trait" rather that a "state" and that patterns of adherence may be established during adolescence or even earlier. (17) Depression has also been found to affect adherence, especially in patients with a chronic illness. (11)

This study specifically addresses the issue of medication adherence of middle adolescents receiving a prescription from a school-based health center in Chicago, Ill. In this study, we explore not only whether students take their medication, but first, whether they were able to fill (obtain) the medication prescription and, if not, the barriers that they experienced. Such baseline data is essential for the development of effective interventions to improve adherence with prescription medications among students receiving care in a school-based clinic.

METHODS

Study Population

The study took place in a middle school (sixth to eighth grades) health center between January and June 2003. Parents were invited to enroll their child in the school-based health center at the time of enrollment of their child in the school; a total of 418 students were enrolled in the health center during the study period. The school is located in a multiethnic neighborhood in Chicago, Ill. Students attending the school are 10 through 15 years old.

A student had to be enrolled in the health center in order to be eligible to participate in the study. …