Pushy parents, sulky teenagers, uncommunicative children and the possibility of having to explain an off-label prescription - GPs may secretly dread visits from the younger patients on their practice list.
Young people can make up a fifth of a practice's list and last year they received 37.6 million prescription items dispensed in the community in England, an average of nearly four items per head.
Improvements in diagnosis and therapy for long-term conditions such as asthma, diabetes and epilepsy mean that many young people now take medicines on a regular basis. In any given week, 20 per cent of all young people at school have taken a medicine.
So how can GPs best encourage young people to use their medicines safely?
Encouraging concordance
Studies suggest that concordance is lower in children than in adults, particularly in adolescents as they approach independence. According to the WHO, in children and adolescents it averages just 58 per cent in developed countries.
Medication beliefs have been found to be more powerful predictors of reported adherence than clinical and sociodemographic factors.
In paediatric medicine, GPs have two audiences to address: young people themselves and their parents. It may seem time consuming, but it is well worth exploring the medication beliefs held by child and parent, and involving them both in decisions about treatment.
Doing this should pay dividends in better prescribing and increased adherence.
Off-label prescribing
In general practice, at least one in 10 medicines prescribed for children is off-label or unlicensed.
These prescribing decisions are based on a 'body of responsible opinion', not on evidence-based research, and GPs must weigh up the risk of withholding a potentially beneficial product against that of treating a patient with what is technically an experimental therapy.
Young patients and their parents may find this alarming, especially if someone other than the prescribing doctor tells them the drug is off-label or unlicensed.
Effective information
Good information effectively communicated has to be a central part of any strategy to improve adherence in children and young people.
Shared decision-making is more effective if children and their parents understand the basis for the doctor's recommendation and how the medicine compares with other options.
Survey findings tell us that people want more information, that they want it from a range of sources and that they value the patient information leaflet more highly than any source of information, except doctors and pharmacists.
An information leaflet is provided with every medicine, and recent legislation requires them to be user tested. The number of people who read them seems likely to grow, therefore, making it all the more important for doctors to inform patients about off-label use or side-effects first.
Youngsters' concerns
Young people's information needs are likely to differ from those of their parents, and delivering the information will require a flexible approach.
Young people may be less concerned about the mechanics of taking a medicine (when and how) than about its day-to-day impact and how their peers will respond.
Even without a parent present, adolescents may find it difficult to introduce topics such as drinking alcohol while on medication, or to voice questions that might suggest poor adherence and generate disapproval.
Young people new to driving might not realise that medicines they may have taken for years could affect their driving ability.
Peer-generated support is one way to address such issues, and many of the patient support groups for long-term conditions that affect young people have materials or hold courses and events.
The Expert Patient Programme also has a young trainers team and the chronic disease self-management course has been adapted to address specific concerns of young patients.
This year's theme for the Ask About Medicines campaign is 'asking about medicines as we grow up'. Materials include a lesson pack to help health professionals and teachers deliver lessons on the importance of asking questions about medicines.
Communication
Encouraging young people to ask questions about their medicine is a good way to create a two-way dialogue between GP and patient, enhancing the likelihood of a shared and mutually informed decision on the most appropriate treatment.
Talking directly to the young patient and not exclusively to their parent is important.
If oral communication is not working then pointing the young person in the direction of reliable information on the internet is another useful strategy.
By helping GPs with the challenge of communicating with children and young people, we hope to make it easier for medicines to be used safely and effectively in young patients.
Ms Letts is director of Ask About Medicines and Professor Haslam is president of the RCGP
Ask About Medicines Week runs from 5-9 November. For more information, visit www.askaboutmedicines.org.
Common questions from young people
- WHAT is this medicine called?
- WHAT does it do?
- WHY do I need to take this medicine?
- WHO should look after it?
- HOW do I take this medicine?
- WHEN should I take this medicine?
- HOW long will I need to take it for?
- COULD there be any side-effects when I take this medicine?
- WHERE can I go for more information?
References
- Health and Social Care Information Centre. Prescriptions Dispensed in the Community: statistics for 1996 to 2006: England. July 2007. www.ic.nhs.uk/statistics-and-data-collections/primary-care/ prescriptions/prescriptions-dispensed-in-the-community-1996-2006- %5Bns%5D.
- Dengler R, Roberts H. Adolescents' use of prescribed drugs and over-the-counter medicines. J Pub Health 1996;18:437-42.
- Costello I, Wong I C, Nunn A J. A literature review to identify interventions to improve the use of medicines in children. Child Care Health Dev 2004;30:647-65.
- WHO. Adherence to long-term therapies: Evidence for action. 2003. www.who.int/chp/knowledge/publications/adherence_report/en/index.html.[Q Q] - Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic illness. J Psychosom Res 1999;47:555-67.
- DoH. NSF for children, young people and maternity services: Medicines for children and young people. September 2004. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPoli cyAndGuidance/DH_4089102.
- MORI. The Public and Prescribed Medicines, November 2004; www.ipsos-mori.com/polls/2004/medicines-partnership.shtml.
