Discussion
Data collected as part of our QI initiative show that children and AYAs
face a wide range of barriers to anticoagulation adherence. For patients
prescribed an oral anticoagulant, the most frequently endorsed barriers
included forgetting to take the medication, medication side effects, and
alteration of lifestyle required secondary to taking the medication. For
patients prescribed an injectable anticoagulant, the most common
barriers included medication side effects, alteration of lifestyle
required secondary to taking the medication, and pain. Of note,
caregivers and patients reported different top barriers and when both
completed measures (in the 31 dyads), 55% of the barriers endorsed
differed across reporters. These data highlight the importance of
assessing the barriers perceived by all stakeholders involved in
adherence management, as perceptions of barriers and their impact on
adherence behavior may vary across individuals.
Consistent with studies from other pediatric medical populations, a
greater number of barriers was associated with lower adherence per
patient- and caregiver-report.16-18 While results are
limited by the lack of demographic and clinical data, missing data, lack
of objective adherence measurement, and single site design inherent in
the collection of data as part of a QI initiative, they suggest that
targeting barriers may be a promising avenue for improving adherence in
children and young adults prescribed anticoagulants. Critical next steps
include standardizing and optimizing adherence measurement and
developing and evaluating interventions for this population.
Conflict of Interest Statement: The authors have no conflicts
of interest associated with this publication, and there has been no
significant financial support for this work that could have influenced
its outcome.