INFLUENCES ON TREATMENT
ADHERENCE IN CHILDHOOD
The wide-ranging influences on adherence to chronic illness treatment are considered in this section. These range from broad systemic factors, such as managed care and reimbursement for services to promote adherence, to more specific factors, such as the quality of patient-physician communication and patient and family knowledge of the treatment regimen.
Walders and colleagues' chapter (chap. 9) focuses on a description of the relationship among treatment adherence for chronic illness, child health policy, and managed care. Given the high rates of nonadherence and the potential health implications of children with chronic health conditions, understanding the effects of managed care on the ability of health care providers to promote treatment adherence is an important concern. Walders and colleagues review the potential impact of nonadherence to treatment in chronic illness on functional morbidity, health care costs, and evaluation of findings from clinical research.
Chapter 9 also considers the potential impact in changes in health care delivery on the care of children with chronic health conditions. The authors raise concerns about the potential for a mismatch between the principles of managed care arrangements and the needs of chronic health conditions. These include restrictions available in time for patient contacts and access to specialty care providers and mental health services, all of which may be needed to support optimal management of treatment adherence of chronic health conditions. Moreover, children with special health care needs are at risk for being denied coverage due to their finan-