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Predictors of Adherence to Short-Course Probiotics Among Children with Gastroenteritis who are Enrolled in a Clinical
Katrina F Hurley1, Eleanor A Fitzpatrick2, Jianling Xie3
1Division of Pediatric Emergency Medicine, IWK Health, Halifax, NS, Canada. katrina.hurley@iwk.nshealth.ca.
Insights
Medication adherence in children with acute gastroenteritis (AGE) was high, with longer diarrhea duration and study site predicting better adherence. Younger age, severe dehydration, and more episodes predicted lower adherence.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pharmacy
- Infectious Diseases
Background:
- Understanding medication adherence is crucial for effective treatment of acute gastroenteritis (AGE) in children.
- Adherence to discharge medications in emergency departments (ED) and research trials requires further investigation.
- This study focuses on quantifying medication adherence and identifying its predictors in pediatric AGE patients.
Purpose of the Study:
- To quantify medication adherence in children with acute gastroenteritis (AGE) treated in an emergency department (ED) setting.
- To identify factors influencing medication adherence in pediatric patients with AGE.
- To assess the concordance between patient-reported adherence and objective measures (sachet counts).
Main Methods:
- Secondary analysis of a randomized trial involving probiotics for pediatric AGE.
- Inclusion of previously healthy children aged 3-47 months with AGE.
- Primary outcome: patient-reported adherence (>70% of prescribed doses); Secondary outcomes: predictors of adherence and concordance with sachet counts.
Main Results:
- 760 participants were analyzed; self-reported adherence was high and similar between probiotic (77.0%) and placebo (80.3%) groups.
- Good agreement (87%) was found between self-reported adherence and returned medication sachet counts.
- Multivariable analysis identified longer diarrhea duration and study site as positively associated with adherence; younger age (12-23 months), severe dehydration, and more vomiting/diarrhea episodes as negative predictors.
Conclusions:
- High medication adherence was observed in children with AGE.
- Factors such as longer diarrhea duration and study site positively influenced adherence.
- Younger age, severe dehydration, and increased episodes of illness negatively predicted adherence, highlighting specific populations needing closer monitoring.
Background:
To improve our understanding of adherence to discharge medications in the ED and within research trials, we sought to quantify medication adherence and identify predictors thereof in children with acute gastroenteritis (AGE).
Methods:
We conducted a secondary analysis of a randomized trial of twice daily probiotic for 5 days. The population included previously healthy children aged 3-47 months with AGE. The primary outcome was patient-reported adherence to the treatment regimen, defined a priori as having received >70% of the prescribed doses. Secondary outcomes included predictors of treatment adherence and concordance between patient-reported adherence and the returned medication sachet counts.
Results:
After excluding participants with missing data on adherence, 760 participants were included in this analysis: 383 in the probiotic arm (50.4%); and 377 in the placebo arm (49.6%). Self-reported adherence was similar in both groups (77.0% in probiotic versus 80.3% in placebo). There was good agreement between self-reported adherence and sachet counts (87% within limits of agreement (-2.9 to 3.5 sachets) on the Bland-Altman plots). In the multivariable regression model, covariates associated with adherence were greater number of days of diarrhea post-emergency department visit, and the study site; covariates negatively associated with adherence were age 12-23 months, severe dehydration and greater total number of vomiting and diarrhea episodes after enrolment.
Conclusions:
Longer duration of diarrhea and study site were associated with higher probiotic adherence. Age 12-23 months, severe dehydration and greater number of vomiting and diarrhea episodes post enrolment negatively predicted treatment adherence.
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