“In pediatric and adolescents with a chronic illness, do electronic resources and electronic communication based interventions

improve positive treatment outcomes and treatment adherence?”

Search Strategy • Databases searched: CINAHL, Academic Search Premier, MEDLINE and AUM’s Cochrane. • The keywords used in our search included: pediatrics, adolescents, electronics, compliance, adherence, text-messaging, internet, cell phone, e-health, and e-mail. • To be included in our analysis, studies needed to have a population consisting primarily of pediatric and adolescent patients, published in a peer-reviewed journal, and involve an intervention that used an electronic resource or communication method to improve treatment outcomes. • After searching in the databases and narrowing our article choices, all of our articles came from the CINAHL database.

Recommendations

• When measuring adherence to a medical treatment program, we recommend more than one measure needs to be used. Ideally adherence should be measured using an electronic monitor and a daily diary that operates through the patient’s mobile device. • Grade A • (Militello et al., 2012; Quittner et al., 2008) • Text message and email reminders are extremely effective in improving patient outcomes and need to be timed to coincide with the action they are related to. For example, if a child’s blood glucose needs to be checked before breakfast, the message should be programmed to be delivered shortly before the child eats. • Grade A • (Militello et al., 2012; Hanauer et al., 2009) • Reminders should be sent to patients to bring materials pertinent to their health maintenance (e.g. blood glucose meters and medication lists) to their clinical visits. • Grade B • (Hanauer et al., 2009)

Summary of Evidence

• Young people are a difficult age group for health care providers to reach and promote treatment adherence and healthy behaviors.

• Adherence to medication regimens is usually below 50% and poor treatment compliance is the number one cause of treatment failure (Quittner et al., 2008).

• Personalization of messages, timing of messages, and the use of text message over E-mail showed improved treatment adherence and compliance (Cushing & Steele, 2010; Hanauer et al., 2009; Militello et al., 2012)

• Studies showed great correlation between electronic interventions and health improvements in the pediatric patients

• The liver transplant study showed decreased rejection rates in pediatric transplant patients receiving text message reminders (Miloh et al., 2009).

• “Sweet Talk” study showed 81% improved self-management of pediatric diabetes patients receiving reminder text messages (Franklin et al., 2006).

• Automated message systems are found to be cost effective, time efficient, and close the generation gap (Militello et al., 2012; Franklin et al., 2006)

• Research in this subject are still new and more studies need to be conducted