Examining Parental Medication Adherence as a Predictor of Child Medication Adherence in Pediatric Anxiety Disorders. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Bushnell, Greta A.; Brookhart, M. Alan; Gaynes, Bradley N.; Compton, Scott N.; Dusetzina, Stacie B.; Stürmer, Til
• Is Part Of: Medical care. Volume 56:Issue 6(2018)
• Publication Date: 2018-06
• Subjects: medication adherence -- antidepressant -- anxiety disorders -- child -- parents; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000911
• Languages: English
• ISSNs: 0025-7079

Abstract

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. Abstract : Supplemental Digital Content is available in the text.