The Impact of COVID-19 on Pediatric Adherence and Self-Management

Jill M. Plevinsky, PHD; Melissa A. Young, PSYD; Julia K. Carmody, PHD; Lindsay K. Durkin, MS; Kaitlyn L. Gamwell, PHD; Kimberly L. Klages, PHD; Shweta Ghosh, PHD; Kevin A. Hommel, PHD

Disclosures

J Pediatr Psychol. 2020;45(9):977-982. 

In This Article

Abstract and Introduction

Abstract

The COVID-19 pandemic has presented unique circumstances that have the potential to both positively and negatively affect pediatric adherence and self-management in youth with chronic medical conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders, school closures, changes in pediatric healthcare delivery) impact disease management at the individual, family, community, and healthcare system levels. We also discuss how barriers to pediatric adherence and self-management exacerbated by the pandemic may disproportionately affect underserved and vulnerable populations, potentially resulting in greater health disparities. Given the potential for widespread challenges to pediatric disease management during the pandemic, ongoing monitoring and promotion of adherence and self-management is critical. Technology offers several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover, pediatric psychologists are uniquely equipped to develop and implement adherence-promotion efforts to support youth and their families in achieving and sustaining optimal disease management as the current public health situation continues to evolve. Research efforts addressing the short- and long-term impact of the pandemic on pediatric adherence and self-management are needed to identify both risk and resilience factors affecting disease management and subsequent health outcomes during this unprecedented time.

Introduction

Under typical circumstances, approximately 50% of children and 65–90% of adolescents are nonadherent to their treatment regimens (Hommel et al., 2009; Logan et al., 2003; Rapoff, 2010). Nonadherence adversely impacts health outcomes and often leads to unnecessary treatment escalation (Carmody et al., 2019), as well as increased healthcare utilization (McGrady & Hommel, 2013). Given the prevalence and multi-faceted impact of nonadherence on pediatric health outcomes, the primary goal of this article is to identify and address how circumstances surrounding the COVID-19 pandemic may affect adherence and self-management among youth with chronic medical conditions. This article will (a) provide an overview of the ways in which the COVID-19 pandemic may exacerbate barriers to adherence and self-management; (b) address healthcare disparities including how COVID-19 may result in greater consequences for adherence and self-management among underserved populations; and (c) offer suggestions for adapting and virtually delivering evidence-based interventions for monitoring and promoting pediatric adherence and self-management during COVID-19.

The pediatric self-management model (Modi et al., 2012) conceptualizes pediatric disease management as not only medication-taking but also healthcare maintenance tasks (e.g., blood draws, routine procedures, appointment attendance), adjunct therapies (e.g., physical therapy), and health behaviors (e.g., exercise, nutrition, sleep). The model poses that both modifiable (i.e., psychological symptoms, treatment regimens) and nonmodifiable (i.e., cognitive function, socio-demographics) factors influence adherence to disease management tasks across the following four levels: individual, family, community, and healthcare system. While the long-term impact of COVID-19 on health outcomes remains unknown, the immediate obstacles to self-management and treatment adherence are apparent and ever present across multiple systems, and each of these domains has been strained by the pandemic. Therefore, it is important to identify and address potential factors specific to the COVID-19 pandemic that may exacerbate poor adherence and self-management and highlight how pediatric psychologists can support these behaviors as the pandemic continues.

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