Promoting Treatment Adherence in Childhood Chronic Illness: Challenges in a Managed Care Environment
Case Western Reserve University
There is a critical need for pediatric professionals to serve as child advocates to enhance the physical, cognitive, emotional, and social potential of children and adolescents ( American Academy of Pediatrics, 1998). One key area of advocacy focuses on promoting adherence to treatment regimens for children with chronic health conditions. The need for such advocacy efforts stems from the importance of treatment adherence as a public health concern and the difficulties in managing nonadherence complications within the current medical care system. The scope of nonadherence to prescribed medical regimens among pediatric populations has been well documented, with rates of nonadherence ranging from 17% to over 90% of pediatric patients ( Lemanek, 1990). Nonadherence to medical treatment has been identified as a major public health problem implicated in potentially avoidable functional morbidity and economic consequences ( Sclar, Tartaglione, & Fine, 1994).
Examining the effects of recent changes in health care on the capacity of pediatric health professionals to provide optimal care for children with chronic conditions, and on the ability of patients and families to adhere to medical regimens for chronic conditions, is an important advocacy concern ( Kelly, 1995). In a relatively short time span, managed care has emerged as the dominant market force in health care, replacing the predominance of the traditional fee-for-service indemnity plan approach, in which enrollees have access to a largely unrestricted choice of health care professionals and provider discretion is primary in health care decision