Paeds Cases · adolescent-and-young-adult-medicine
Medication adherence and treatment fatigue OSCE — assessment, measurement and the tailored plan
Observed structured encounter testing a non-judgemental adherence assessment, multimodal measurement interpretation, barrier mapping, and a tailored adherence-promotion plan with a safety override.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a private adherence assessment with a 16-year-old with cystic fibrosis whose self-report conflicts with refill data. Station B is a transplant recipient nearing transfer with subtherapeutic tacrolimus and a disclosure that must be handled safely.
Station objectives
- Open the adherence conversation with a non-judgemental, normalising frame and time alone. [1] [5]
- Take a structured adherence history across initiation, implementation and persistence. [1]
- Interpret discordance between self-report and objective data without blame. [2]
- Build a tailored plan: shared goals, motivational interviewing, regimen simplification with the team, reminders, family-based support. [3] [5]
- Recognise and act on red-flag consequences and the transition cliff. [4]
References5ShowHide
- [1]Hanghøj S, Boisen KA Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review. Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2014.PMID 24182940
- [2]Modi AC, Lim CS, Yu N, Geller D, Wagner MH, Quittner AL A multi-method assessment of treatment adherence for children with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 2006.PMID 16679071
- [3]Palacio A, Garay D, Langer B, Taylor J, Wood BA, Tamariz L Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis. Journal of general internal medicine, 2016.PMID 27160414
- [4]Fredericks EM, Dore-Stites D, Well A, Magee JC, Freed GL, Shieck V Assessment of transition readiness skills and adherence in pediatric liver transplant recipients. Pediatric transplantation, 2010.PMID 20598086
- [5]Drotar D Strategies of adherence promotion in the management of pediatric chronic conditions. Journal of developmental and behavioral pediatrics : JDBP, 2013.PMID 24247913