Background: Symptoms of inflammatory bowel disease (IBD) include bloody diarrhea, fatigue, abdominal pain, and weight loss. Long-term management of remission for most patients requires adherence to taking 1 or more oral medications daily, in the absence of symptoms. We investigated whether disease characteristics and behavioral characteristics predict adherence to prescribed medical regimens.
Methods: Patients aged 8 to 17.5 years, newly diagnosed with IBD, and a matched cohort previously diagnosed were studied over a 6-month period. Adherence was assessed using medication electronic monitoring devices (Medication Event Monitoring Systems); participants and parents completed questionnaires regarding emotional and behavioral functioning, and biological parameters were monitored.
Results: Adherence was monitored for 45 newly and 34 previously diagnosed patients. In total, 16,478 patient-days (including 12,066 discrete days) were electronically monitored. Overall, 70.6% of 5-aminosalicylic acid and 65.4% of 6-mercaptopurine doses were taken. Only 25% and 15% of older adolescents took at least 80% of their 5-aminosalicylic acid and 6-mercaptopurine, respectively, compared with about 83% and 64% of 8-year-olds to 11-year-olds. Only age and behavioral issues were statistically linked to rates of adherence.
Conclusions: Adherence to commonly prescribed oral medications for IBD is challenging for patients. Screening for emotional and behavioral problems, especially among older adolescents, would be important in identifying patients at risk of poor adherence, who might benefit from interventions. Biological solutions, although critical, when applied without attention to behavioral issues, are not likely to provide the level of therapeutic benefit that can be provided in a combined biobehavioral approach.
Article first published online 26 February 2013
*Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, Department of Pediatrics, Hasbro Children’s Hospital/Rhode Island Hospital, Providence Rhode Island
†Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
‡Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, Rhode Island
§Bradley Hasbro Research Center, Providence, Rhode Island.
Reprints: Neal S. LeLeiko MD, PhD, Department of Pediatrics, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, MPH Rm 134, 593 Eddy Street, Providence, RI 02903 (e-mail: firstname.lastname@example.org).
Supported by the National Institutes of Health Grant R21 HDO58828NL. D. Lobato was supported in part by the National Institutes of Health Grant R21 HD058828.
N. S. LeLeiko and D. Lobato contributed equally to this work.
Presented in part at a platform session of Digestive Diseases Week (American Gastroenterological Association), May 2011, Chicago, IL.
The authors have no conflicts of interest to disclose.
Received July 01, 2012
Accepted July 02, 2012