Adherence to Medical Treatment
in Pediatric Chronic Illness:
Critical Issues and Answered Questions
Kristin A. Riekert
Case Western Reserve University and Rainbow Babies
and Children's Hospital, Cleveland, OH
Large numbers of children and adolescents have chronic physical conditions requiring treatment regimens that are complex, are time-consuming, and need to be managed over the course of a lifelong illness ( Newacheck & Taylor, 1992). Increasing numbers of children and adolescents with lifethreatening chronic conditions now survive into adolescence and early adulthood. The quality of life for these children/adolescents and their families may be influenced by their abilities to successfully manage their treatments. Child and family nonadherence with treatment regimens for pediatric chronic illness has also been recognized as an important clinical problem that can lead to unnecessary hospitalizations, increased risk for illness-related complications, and more costly medical care costs ( La Greca & Schuman, 1995). Recent trends in health care have also increased the importance of treatment adherence to ensure optimal medical outcomes. For example, advances in illness management such as intensive therapy for conditions such as diabetes have been shown to decrease the rate of diabetes-related complications ( Diabetes Control and Complications Trail Research Group, 1993). Moreover, new anti-retroviral treatments that are now available to treat HIV infection ( Vernazza et al., 1997) offer new hope to affected children, adolescents, and adults. However, such intensive treatments are quite demanding and often difficult for children, adolescents, and their families to manage.
Other recent developments in health care, such as shorter duration of hospital stays and limitations in reimbursement, place significant constraints