Non-Adherent Kids Make More Hospital Trips

A review of previous studies finds that children with chronic conditions who fail to take their medications as prescribed are more likely to visit the emergency department and be hospitalized.

Approximately 50% to 88% of children and adolescents with chronic illnesses do not take their medications as prescribed, and a recent review finds that just like adults, non-adherence in children leads to more hospitalizations and emergency department visits.

The systematic review, published online on September 2, 2013, in Pediatrics, analyzed the relationship between poor medication adherence and health care use in children aged 18 and younger diagnosed with a chronic medical condition. For their review, the researchers used 10 relevant studies published before April 2013. Of the studies, 9 involved children with asthma, and 1 included children with type 1 diabetes.

A reviewer collected data from the included studies and a second reviewer evaluated the information for accuracy. Health care use data was categorized as emergency department visit, outpatient visit, hospitalization, or other. Information on health care use was measured by caregiver self-report, reviews of electronic medical records, or reviews of insurance databases, depending on the study. Methods for measuring adherence also varied among the studies and included using pharmacy refill records, self-reports, and electronic monitors.

Of the 10 studies included in the analysis, 9 indicated a relationship between poor medication adherence and increased health care use. Of the 7 studies that focused on adherence and emergency department visits in children with asthma, 6 reported that a decrease in medication adherence was related to an increase in trips to the emergency department. Children diagnosed with asthma who did not fill any prescriptions for anti-inflammatory medications were significantly more likely to visit the emergency department than were children who filled at least 1 prescription. Children who took their medication less often and those who had their medication on-hand fewer days throughout the year were also more likely to visit the emergency department than were adherent children.

Half of the studies included in the review analyzed adherence and hospitalization risk. In the 4 studies that included children with asthma, those who did not fill any prescriptions were at an increased risk for hospitalization. In the study that included children with type 1 diabetes, non-adherence was associated with a greater risk of hospitalization for diabetes-related complications.

The reviewers found that children who had poor medication adherence were also less likely to have regular outpatient visits to manage their condition. In one study, children with asthma who had not filled a prescription for a controller medication in the past 3 months were less likely to have asthma-related physician visits than children who had filled prescriptions. Similar results were found in a second study.

The only study to analyze costs related to non-adherence in children found that caregivers saved more money by not filling prescriptions than they spent on extra hospitalizations and emergency department visits resulting from non-adherence. This finding runs counter to the findings of a recent review suggesting that non-adherence in adults increases overall health care spending. The authors of the review note, however, that the findings from the study in children may be misleading, as the follow-up was short and failed to capture long-term costs associated with non-adherence.

Given the small sample of relevant studies included in the review, the authors suggest that more research is needed to analyze potential savings that could be produced if medication adherence in children were improved.

“To broaden the literature base in this important field, future research examining adherence should include health care use and cost analyses and be conducted with additional illness populations,” they write.