? Therapeutic advances have enabled more children afflicted with chronic diseases to survive into adulthood. As medication and treatment regimens become more effective, therapeutic failures more frequently result from failure to adhere to prescribed medication regimens. One factor that contributes to medication non-adherence in adolescents is the failure to take into account adolescent and caregiver preferences or sensitivities to medication outcomes. We need to improve communication with adolescents and caregivers and gain a better understanding of the medication-specific characteristics that are important to adolescents. The primary goal of this K23 proposal is to train Renee F. Robinson, PharmD, MPH as an independent clinician-scientist. A five-year training program is proposed that emphasizes mentoring and formal coursework in shared medical decision making. The proposed training will provide Dr. Robinson with the necessary patient-oriented research skills to 1) enhance understanding of the role adolescent and caregiver preferences (utilities) have on medication adherence, 2) establish the relationship of medication adherence with an individual's utilities, and 3) conduct a pilot study of adherence in patients receiving utility-based therapy. The pilot study has been designed to complement and enhance those skills obtained during the developmental period. In Study I, we quantify utilities that adolescents and caregivers assign to various medication outcomes/effects associated with specific medication therapies. In Study II, we test the hypothesis that greater rates of medication adherence are associated with matching of individual utilities to medication therapies chosen after controlling for moderators of adherence. Greater rates of medication adherence may be associated with a match between the preferences of the patient and those of the caregiver and physician. In Study Ill, we test the hypothesis that greater rates of medication adherence can be attained by improved matching of the medication's outcomes with the utilities expressed by the patient, and will obtain pilot data to test the utility assessment method developed in Study II. These data will be used to design an intervention trial, the goal of which will be to improve adherence. The long-term objectives of this training and research are to design, validate, and implement more effective assessment methods to identify risk factors for non-adherence and to improve long-term medication adherence in children and adolescents suffering from chronic renal diseases, such as hypertension or solid organ transplantation ? ?
