Prevalence Of Nonadherence

As yet, the bulk of literature in rheumatology has focused on medication adherence with only a limited attention paid to other aspects of the health regimen. Moreover, few articles pertain to adolescents. Pediatric rheuma-tologists sometimes naively think that parental supervision and/or the likelihood of pain will ensure strict adherence (16). As such, magnitude of adherence with pharmacological and nonpharmacological treatment in adolescents with chronic rheumatic disease remains unknown.

The most common methods for assessing adherence include drug assays, electronic monitors, pill counts, physician ratings, and patient or parental reports. A discussion regarding the merits of these is beyond the scope of this review, but can be found in Kroll et al. (17) and Rapoff (4). As yet, there is no single optimal method, and relying on clinical judgment alone is unreliable. Studies have found that the physician's assessment of adherence is no better that that predicted by chance alone (18).

The following paragraphs summarize what is known about adherence in adolescents with chronic rheumatic diseases. The chapter begins with medication adherence, as this includes the most numerous and evaluative studies, and is followed with the non-pharmacological aspects of care, which is largely based upon the findings of more descriptive studies.

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