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03/06/2014

Young Adults and Medication Adherence

There is little focus on the young adult population (ages 16 to 24) when trying to understand the relationship between age and medication adherence. It is important to categorize them separately from other age groups since they are at a distinctly different developmental point in their life compared to children and adults. There are many factors that influence medication adherence in adolescents. Exploring these factors, particularly the barriers, through a disease state such as human immunodeficiency virus (HIV), will allow us to appreciate the many challenges young adults face when taking medications.

Barriers:  Adolescent years are crucial years, behaviorally and developmentally, as it is when children gain independence and start to develop personal opinions. Matsui sheds light on the relationship between parent and adolescents and their involvement in medication adherence, by noting that there may be a chance for family conflict and rebellion. It may be a new concept for adolescents to be in charge of their own health and therefore they may stop taking medications or listening to their parents. Although young adults attain greater independence, these are the years that parents can assist adolescents manage their own health, in contrast to when they were children.  

Besides new gained independence, the lack of knowledge regarding medication therapy may also act as a barrier for young adults to take medications. Once young adults take charge of their own medications, they may worry about adverse events. In a review article, Matsui states that cosmetic changes such as acne and weight gain may prevent young adults from continuing therapy. An unfortunate event of adverse effects may prevent adolescents to better understand their disease state and find a solution to improve medication adherence.

Another barrier that author Huang mentions is that young adults tend to focus on what their peers may think and therefore cancel doctor visits and follow ups. This factor/barrier may influence adolescents to discard their therapies because of the fear being judged for having a specific disease state. Adolescents may not want their friends to know that they have a disease such as diabetes or asthma that needs to be managed with prescription medications.  A disease state that depends on adherence for improvement but adolescents counter many challenges is HIV.

HIV:  It is very important to address adherence issues in adolescents with HIV, because viral load is controlled when adolescents abide to an adequate therapy. A study conducted by MacDonell and colleagues, focuses on the influence of situational temptation and non adherence in young adults with HIV. They defined situational temptations as lack of support, needing a break from medications and not seeing a need for prescribed medications. The study results showed that family support or reminder and limited knowledge regarding purpose of HIV medication, were all significant factors that played a role in the young adults’ temptation to disrupt HIV medications. It was evident that adolescents who experienced optimal adherence had a lower number situational temptations showing that barriers do influence medication adherence.

As healthcare providers it is essential that pharmacists identify and help overcome the challenges that many adolescents face when managing medication therapies.  Pharmacists can recommend solutions such as getting parents involved to improve support and providing prescription information to increase the patient’s medical knowledge. Pharmacists also have the opportunity to help young adults navigate negative peer influence that may act as an obstacle to optimal adherence. Therefore, it is important for pharmacists to recognize and address adherence barriers unique to this population of patients.

Sheenu Joseph, PharmD '15

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