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Med Care. 2018 Jun;56(6):510-519. doi: 10.1097/MLR.0000000000000911.

Examining Parental Medication Adherence as a Predictor of Child Medication Adherence in Pediatric Anxiety Disorders.

Author information

1
Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health.
2
Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.
3
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham.
4
Department of Health Policy, School of Medicine, Vanderbilt University Medical Center, Nashville, TN.

Abstract

BACKGROUND:

Selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety disorders but adherence remains difficult to predict.

OBJECTIVES:

To estimate SSRI adherence in children with anxiety disorders and determine if prior parental medication adherence is predictive of child high SSRI adherence.

METHODS:

We identified children (3-17 y) initiating SSRI treatment after an anxiety disorder diagnosis in a commercial claims database (2005-2014). We evaluated parent SSRI, statin, and antihypertensive adherence [6-mo proportion days covered (PDC), high adherence=PDC≥0.80] in the year before child SSRI initiation. We estimated risk differences (RD) of child high SSRI adherence (6-mo PDC) stratified by parent adherence and multivariable risk ratios using modified Poisson regression. We estimated change in c-statistic and risk reclassification when adding parent-level covariates with child-level covariates to predict child adherence.

RESULTS:

In 70,979 children with an anxiety disorder (59%=female, 14=median age), the mean 6-month SSRI PDC was 0.72, with variation by anxiety disorder. Overall 64% of children had high adherence if their parent had high SSRI adherence versus 53% of children with parents with low SSRI adherence (RD, 12%; multivariable risk ratios, 1.17; 95% confidence interval, 1.14-1.20). Findings were similar for parent statin (RD=10%) and antihypertensive adherence (RD=8%) and when stratified by child age and parent sex. There was minor improvement in risk reclassification and the c-statistic after adding parent adherence and parent-level covariates.

CONCLUSIONS:

Parental medication adherence could help providers identify children at risk of nonadherence to inform the treatment decision, reduce unnecessary medication switches, and lead to broader effective interventions.

PMID:
29668649
PMCID:
PMC5945329
[Available on 2019-06-01]
DOI:
10.1097/MLR.0000000000000911

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