cational programs). Some educational programs have been successful in increasing medication knowledge and self-efficacy among patients. In a self-management program, asthmatic patients who were taught the appropriate use of inhalers were able to demonstrate the devices’ correct use when tested (van der Loos, 1989). In another program, patients who were taking nonaspirin NSAIDs improved the recall of their medication use after being shown lists and pictures of their medications (Kimmel et al., 2003). A telephone system for monitoring and counseling patients with hypertension helped improve medication adherence for 18 percent of the 133 patients who used the system and for 12 percent of the 134 patients in the control group (p = 0.03), and decreased diastolic blood pressure (5.2 mm Hg in telephone users versus 0.8 mm Hg in controls, p = 0.02) (Friedman et al., 1996).

A systematic review of published randomized controlled trials on interventions to improve patients’ adherence to prescribed medications (McDonald et al., 2002) found that 49 percent of the interventions tested (19 of 39 interventions in 33 studies) were associated with increases in adherence, while 17 were associated with reported improvement in outcomes. Two studies found that dosing once a day led to higher adherence than dosing twice a day, but not better clinical outcomes (Baird et al., 1984; Girvin et al., 1999). A third study found that dosing twice a day resulted in higher adherence than dosing four times a day and better clinical outcomes as well (Brown et al., 1997). In general, however, the investigators (McDonald et al., 2002) found that the most effective interventions for long-term care were complex; these interventions included more convenient care, information, counseling, reminders, self-monitoring, reinforcement, family therapy, and other forms of supervision. However, the investigators concluded that even the most effective interventions had modest effects.

The School Setting

The website of the Center for Health and Health Care in Schools provides information on state policies regarding the administration of medications in schools (Health in Schools, 2004). The center has also identified a set of issues that a school medication management policy might include, for example, the responsibility for medication use the school is willing to assume, the responsibilities required of the patient and parents, the rules for self-medication, and feedback mechanisms so that parents can learn about a medication’s effect (Robinson, 2004). The American Academy of Pediatrics (Committee on School Health, 2003) has also developed a set of guidelines for the administration of medications in schools. Of more practical help, the Florida Society of Health-Systems Pharmacists has developed a resource manual for medication use in schools (Johnson et al., 2003). The



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