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Table 1

From: Improving adherence to medical regimens for juvenile rheumatoid arthritis

Recommendations for Enhancing Adherence in Pediatric Rheumatology
1. Educate patients and families about the goals of treatment. Negotiate with them upfront about which treatments they are willing to try.
2. Make regimens as simple as possible and consistent with the patients' daily routine.
3. Educate patients and families about how to minimize treatment side effects and problem solve with them to address other barriers to adherence.
4. Ensure that patients and families have the requisite behavioral skills to implement regimens. Rehearse these in the clinic (e.g., demonstrate and have patients practice therapeutic exercises).
5. Encourage patients and caregivers to monitor adherence (e.g., use a calendar posted in a prominent place in the home).
6. Teach caregivers positive reinforcement strategies for promoting adherence (e.g., point system for adhering to regimen components).
7. Review discipline strategies with caregivers for children who are oppositional (e.g., time-out for younger child who refuses medications).
8. Teach older patients self-management strategies (e.g., problem-solving).
9. Refer patients and families to qualified mental health providers if more serious problems exist concurrently with nonadherence or are directly interfering with adherence.
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