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  • Predictors of Adherence to Treatment Recommendations for Positional Skull Deformity in Infants

    Final Number:

    I-Wen Pan PhD; Sandi Lam MD MBA; Bradley Daniels BS; Thomas G. Luerssen MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: The WHO defined that adherence is “the extent to which a person’s behavior corresponds with agreed recommendations from a health care provider. “ The study aims to understand factors associated with adherence to initial recommended treatment among pediatric patients with positional skull deformity.

    Methods: We aimed to review our institutional experience (2008-2014) in treatment of positional plagiocephaly to explore factors associated with adherence to recommended treatment. A retrospective chart review was conducted. Reported adherence was recorded. Univariate and multivariate analysis was used to assess the impact of patient clinical and demographic characteristics on adherence.

    Results: 991 patients age <12 months presented to the Texas Children’s Hospital Head Shape Deformities Clinic from 2008-2014. According to our age- and risk-factor-based treatment algorithm, patients were recommended for repositioning, physical therapy, or helmet therapy. 85.7% patients were adherent to initial recommended treatment. Average age at presentation was 6.2 months. 40.7% were white and 32.6% Hispanic. The proportion of commercial insurance to Medicaid was 38.7%, 37.9%. Univariate analyses shows difference in adherence rates. Children with Medicaid had adherence rate 80.2%, and commercial insurance, 89.6%. Multivariate logistic regression confirmed factors associated with adherenceincluded primary insurance payer, diagnosis (plagiocephaly versus brachycephaly), and recommended treatment. Patients with Medicaid, brachycephaly, and recommended for helmet therapy were less likely to be adherent than patients with plagiocephaly recommended for repositioning/physical therapy. Patients with commercial insurance (Odds ratio=1.49, 95%Confidence interval 1.10-2.02, p=0.009), both brachycephaly and plagiocephaly(OR= 2.26, 95% CI 1.31-3.90, p=0.003), recommended treated with Helmet(OR = 4.55, 95% CI = 3.24-6.38, p<0.001), and living in proximity (<12 miles) to the provider facility (OR=1.40, 95% CI 1.00-1.96, p = 0.047) were more likely to complete treatment .

    Conclusions: Insurance type, degree of head shape deformity, and proximity to health care facility appear to affect rates of adherence to recommended treatments for positional skull deformation.

    Patient Care: This research will help practitioners recognize clinical and socioeconomic factors that may be barriers to adherence to recommended care in positional skull deformity.

    Learning Objectives: At the conclusion of this session, participants should be able to: (1) define adherence (2) describe factors affecting rates of adherence to recommended treatment in positional skull deformity


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