Abstract
This chapter presents the case of a 14-year-old boy with ESRD who develops nonadherence to his oral medications. Initial interventions (encouragement, education, discussion of reminder strategies) were unsuccessful, and he was referred to Psychology. Assessment revealed a number of factors contributing to his decreased adherence, including a change to his routine, abrupt transition of responsibility for the prescribed treatment regimen from the parent to the patient, increased parent-child conflict, and the patient experiencing difficulty coping with his chronic health condition.
The chapter discusses the comprehensive evaluation of factors related to adherence, including assessment of baseline adherence to the prescribed treatment regimen, identification of barriers to adherence, parent-child interactions surrounding medical care, and patient emotional and behavioral health. Discussion of evidence-based strategies to improve adherence is presented, including interventions to target unintentional versus volitional nonadherence; interventions to improve parent-child interactions and promote effective transition of responsibility from caregivers to patients; strategies to promote coping with a chronic health condition; and behavioral strategies to address difficulties with pill swallowing. Discussion includes description of the treatment plan for the case presented, tailored to the patient’s situation and the identified barriers to adherence. The chapter concludes with a short list of key lessons.
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Johnson, R.J. (2017). Nonadherence. In: Warady, B., Schaefer, F., Alexander, S. (eds) Pediatric Dialysis Case Studies. Springer, Cham. https://doi.org/10.1007/978-3-319-55147-0_31
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