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Chronic functional constipation in children: adherence and factors associated with drug treatment
Sílvia A Steiner1, Marcia R F Torres, Francisco J Penna
1Department of Pediatrics, Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
Insights
Treatment adherence for childhood constipation is low, with only 30-38% of children adhering to medication regimens. Polyethylene glycol showed better adherence than other laxatives, highlighting the need for improved strategies to manage pediatric constipation.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pharmacy
- Public Health
Background:
- Chronic functional constipation is a common pediatric condition.
- Effective management requires consistent patient adherence to prescribed treatments.
- Low adherence rates can lead to treatment failure, complications, and increased healthcare costs.
Purpose of the Study:
- To evaluate treatment adherence in children diagnosed with chronic functional constipation.
- To identify factors influencing adherence to medication in this pediatric population.
Main Methods:
- A prospective, longitudinal study conducted at a pediatric gastroenterology clinic.
- Utilized Rome III criteria for diagnosis and Bristol Stool Scale for stool characterization.
- Assessed adherence via questionnaires at 1 and 6 months, defining adherence as using >75% of prescribed medication.
Main Results:
- Fifty children completed the 6-month study.
- Adherence rates were 38% at 1 month and 30% at 6 months.
- Patients treated with polyethylene glycol demonstrated significantly higher adherence compared to those on other laxatives at 6 months (P=0.04).
Conclusions:
- Drug treatment adherence for pediatric constipation is notably low.
- New strategies are essential to enhance treatment adherence and improve outcomes.
- Addressing adherence barriers can reduce complications and healthcare expenditures associated with childhood constipation.
Objective:
The aim of the present study was to evaluate the treatment adherence of children with chronic functional constipation.
Methods:
The present study is a prospective and longitudinal study realized at a pediatric gastroenterology clinic of a Brazilian University Hospital, between August 2009 and October 2011. Rome III criteria and the Bristol Stool Scale were used to define constipation and to characterize feces, respectively. Drug treatment was prescribed for patients according to the protocols previously standardized in the clinic. Specific questionnaires, containing questions related to 1 dependent variable and independent variables were completed in the first and sixth months of the treatment. Independent variables related to the patients, their caregivers, the disease itself, and the therapeutic plan were analyzed and compared with the dependent variable (adherence to the treatment). Adherence was considered when the patient returned with >75% of the prescribed medicine containers empty.
Results:
Fifty children participated in both the first and sixth months of treatment. The mean age of the sample was 77.6 ± 43.8 months and the mean age of the onset of symptoms was 18.8 ± 27.9 months. The adherence rate was 38% in the first month and 30% in the sixth month. Patients who were treated with polyethylene glycol had greater adherence than patients who were prescribed other laxatives, with statistical significance in the second moment of the study (P = 0.19 and P = 0.04, respectively).
Conclusions:
The study showed low adherence rates to drug treatment of constipation in children. It is necessary to seek new strategies to increase treatment adherence, while avoiding complications and reducing costs.
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