Adherence to Nutritional Supplementation in Cystic Fibrosis.
Kevin A Hommel, Joseph Rausch, Elizabeth K Towner and 4 others
PMID 31005801WHAT IT FOUND
Over 12 months, 18% of children and adolescents with cystic fibrosis took a nutritional supplement almost perfectly and 42% took it well, while 40% had moderate to low adherence.
Medicaid status differed by adherence group.
Key findings
01Four adherence trajectories were identified: 18% near perfect, 42% good at or above 80%, 16% poor and declining, and 24% consistently low under 30%.
02All groups showed an initial increase in adherence, but around two to three months this increase plateaued or began to decline.
03Insurance status differed by adherence trajectory, with the most adherent and least adherent groups more likely to receive Medicaid than the middle two adherence groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The two supplement groups did not differ significantly and were combined, so the paper does not show whether the supplement affected adherence. Adherence was measured by parent/caregiver packet counts, not electronic monitoring or observed consumption, so packets could have been lost, emptied, or not consumed. The sample was restricted to children and adolescents with cystic fibrosis and pancreatic insufficiency who had mild to moderate lung disease and met exclusion criteria, so it may not apply to more severe lung disease, other ages, or other conditions. The statistical method assigned each participant to one adherence group, so real-life adherence patterns may be less discrete. Insurance status was an observed association, not evidence that Medicaid caused poor adherence.
The easy way to misread this
Do not conclude that LXS or placebo changed adherence. The two supplement groups did not differ significantly and were combined for the trajectory analysis.