Education topples compliance barriers
Ways to address resistance to meds adherence
Education can overcome many of the obstacles to pediatric medication compliance. What’s important to remember is that it takes more than intellectual knowledge to change a person’s behavior.
"Often, a parent knows a lot about a medication but is not administering it correctly," says Phyllis Slutsky, RN, MN, MEd, manager of the community Asthma Prevention Program at Children’s Hospital of Philadelphia.
There are many reasons for parental noncompliance. Some parents have strong beliefs or misconceptions that prevent adherence. For example, with asthma medication, it is difficult to convince parents that it is important to give children the preventive medicine because the child has no symptoms.
There are two types of asthma medicine: long-term-control medicines and quick-relief or rescue medicines. "The biggest problem with asthma management is that most children are undertreated on the preventive side and overtreated with the quick-relief medicines," explains Slutsky.
Children will take their quick-relief medication every couple of hours for coughing and wheezing because they aren’t taking their long-term control medicine, which is what they need to stop the symptoms. To overcome this problem, Slutsky teaches the physiology of asthma, explaining that it is a problem of inflammation. She uses pictures to illustrate the swelling and discusses how the quick-relief medications simply open the airways, but they don’t treat the swelling, which contributes to the asthma attacks.
She uses parent-to-parent teaching as well, because there is always at least one parent in the class who can discuss how his or her child got very sick because the parent only administered the quick-relief medication, which treats the symptoms — not the underlying cause of the problem.
Some parents refuse to give their child a drug because they think it is not safe, says Slutsky. This is particularly true of asthma because steroids have received a lot of bad press, and side effects used to be a problem because of the way the medicine was administered. "Today, the preventive medications are inhaled steroids and have very few side effects, because they don’t go through the bloodstream and very little of the medications are absorbed by the body," she explains. In the community asthma class, Slutsky asks how many parents refused to give their children steroids. About 50% of those attending always raise their hands.
Evaluate understanding
To ensure that parents will give their child the medication, health care professionals need to do more than explain the purpose of the medication; they need to explore the parents’ beliefs about it, says Slutsky. Do they feel it will be beneficial? Are they worried about side effects?
Compliance is complex, agrees Fran London, MS, RN, health education specialist at Phoenix Children’s Hospital. First, the parent has to understand and agree with the diagnosis and treatment. Then the parent has to understand why the child should take the medicine. "Without mutual agreement on these basic issues, you may not get very far," she says.
While the parent may be willing to give the child the medication, the child is not always willing to take it. "We usually get [the counseling department] involved to help with sticker charts or other types of positive reinforcement attempts," says Mary Wooten, RN, BSN, hematology/oncology outpatient nurse manager for Children’s Healthcare of Atlanta.
If the child doesn’t like the flavor of an oral medication, there are creative ways to mask the taste, such as using cherry or chocolate syrup. To help with buy-in, a child as young as 3 years old should be involved in the education process and given a choice of taking a liquid or chewable medicine, if possible.
The child can be given a simple explanation for the reason he or she is taking the medicine, such as, "It will help make your tummy feel better," explains Wooten.
Parents need to understand how to administer the medication correctly. If a liquid medicine is being given to an infant, the health care practitioner should demonstrate how to draw the medication to ensure the right amount is given and then have the parents demonstrate, says Wooten.
It’s important to evaluate the understanding of what was taught. Have the parent repeat the information in his or her own words, and then ask the appropriate questions to clarify understanding, says London. For example, ask parents to explain the meaning of the phrase, "Take the medicine until it is gone. Even if the parent has a PhD, don’t assume when the parent says, I understand,’ the understanding is accurate. Explore it," she advises.
Check for financial problems
Even when all family members agree that the medicine should be taken, finances can prove a hindrance. Find out if the family has transportation to the pharmacy and the money to pay for the prescription, urges London. If there are problems, the social work department can be alerted.
When the education is complete, give parents written instructions, but make sure the one-on-one instruction takes place first. "Because of time constraints, the education often consists of handing parents print materials, and that is not adequate," says Slutsky.
For more information on pediatric medication compliance, contact:
Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children’s Hospital, 909 E. Brill St., Phoenix, AZ 85006. Telephone: (602) 239-2820. Fax: (602) 239-4670. E-mail: [email protected].
Phyllis Slutsky, RN, MN, MEd, Manager, Community Asthma Prevention Program, Children’s Hospital of Philadelphia, 3535 Market St., Suite 1018, Philadelphia, PA 19104. Telephone: (215) 590-5261. Fax: (215) 590-4889. E-mail: [email protected].
Mary Wooten, RN, BSN, Outpatient Nurse Manager, Children’s Hospital of Atlanta, 1001 Johnson Ferry Road N.E., Atlanta, GA 30342. Telephone: (404) 256-5252, ext. 3523. E-mail: [email protected].
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