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Medication nonadherence is frustrating: How to help patients change behavior

September 17, 2021

Editor's note:  For more coverage of the 2021 AAP National Conference & Exhibition, visit

Heather De Keyser, M.D., M.S., FAAP, couldn’t figure out why some of her patients with asthma weren’t improving even though they were on appropriate therapy.

“I would read about amazing medications in clinical trials, but it just didn’t always translate to my patients actually getting better in real life,” said Dr. De Keyser, a pediatric pulmonologist at the Breathing Institute at Children's Hospital Colorado.

It wasn’t until she started “digging into the literature” that she pinpointed the problem —  medication nonadherence.

“I realized that I could truly help my patients by helping them to find strategies to take their medications, rather than continuing to prescribe new medications or higher doses of the same medications,” she said.

Dr. De Keyser describes the problem of nonadherence and offers strategies pediatricians can use with their patients during the on-demand session “It Won’t Work if You Don’t Take It: Ways to Improve Medication Adherence” (OD0188).

Forgoing medicine is a common problem across pediatric diseases. Medication adherence rates range from about 30%-70% for asthma, 16%-89% in sickle cell disease, 30%-70% in solid organ transplant, 10%-60% in multiple sclerosis and 58% for newly diagnosed epilepsy

“These are just a few examples, but … they highlight the fact that even for life-threatening diseases, medication adherence is still a problem,” said Dr. De Keyser, a member of the AAP Section on Advances in Therapeutics and Technology and Section on Pediatric Pulmonology and Sleep Medicine. 

The most common reason patients don’t take their medicine is they simply forget.

“Patients and parents often know that they need to take their medications, but life simply gets in the way,” she said.

Other reasons include poor access to care and medication beliefs or stigma.

During the session, Dr. De Keyser shares strategies pediatricians can use to ask their patients about medication use and help them create positive habits to take it consistently.

“This can be one of the most frustrating aspects of patient care, when you know that you have the appropriate medications to treat disease, but you cannot figure out how to get your patients to take it,” she said. “I aim to give pediatricians tips that they can use, even in busy clinics where time is limited, to help their patients make behavior changes that will improve their quality of life.”

Pediatricians also can use the strategies in their own lives to help them remember to do things like drink water, floss their teeth or exercise, Dr. De Keyser said. “We all have health behaviors we wish we were better at doing.”

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