Discordance between physician and adolescent assessments of adherence to treatment - influence of HbA(1c) level

OBJECTIVE - To compare the subjective assessments (perceptions) of physicia ns and adolescent diabetic patients on the adolescents' adherence to treatm ent and to test the hypothesis that the HbA(1c), level influences physician s' perceptions. RESEARCH DESIGN AND METHODS - In a multicenter cross-sectional survey, 143 adolescents with diabetes (mean age 14.6 years) auto-assessed, while their pediatricians independently assessed, the level of adherence to treatment o n a four-point scale. Scores of adherence given by a validated scale and me tabolic control (HbA(1c),) were compared according to those assessments. RESULTS - Agreement between the adherence perceptions from adolescents and physicians was low (kappa = 0.23), and adolescents scored significantly hig her (P < 0.001). Mean adherence score to diabetes treatment was significant ly higher when the adolescents' perception of their self-care behaviors was good than when it was poor (P = 0.01), but did not significantly differ ac cording to physicians' perception. Mean HbA(1c), level was significantly lo wer when the self-care behavior perception was good than when it was poor, both for the adolescents (P = 0.02) and for the physicians (P < 0.001). Mul tivariate analyses showed that only the adherence scale score was significa ntly associated with the adolescents' perception (P = 0.015), whereas only HMI, level was significantly associated with the physicians' perception (P = 0.0008). CONCLUSIONS - By identifying the possible discrepancy between their own ass essment of adherence and that of adolescents, and by avoiding the systemati c attribution of poor metabolic control to poor adherence, physicians could generate a more confident and collaborative relationship with diabetic ado lescents and therefore facilitate adolescents' self-management.