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Modifiable Factors Associated with Nonadherence to Maintenance Medication for Inflammatory Bowel Disease

Selinger, Christian P. MD, MSc*,†; Eaden, Jayne MBChB, MD; Jones, D. Brian MD*; Katelaris, Peter MBBS, MD*; Chapman, Grace MBBS*; McDonald, Charles MBBS*; Smith, Paul MBChB§; Lal, Simon BSc, MBChB, PhD; Leong, Rupert W. MBBS, MD*,‖; McLaughlin, John BSc, MBChB, PhD; Robinson, Andrew MBChB, PhD

doi: 10.1097/MIB.0b013e31829ed8a6
Original Clinical Articles

Background: Poor adherence frequently impaired the efficacy of therapy to maintain remission from inflammatory bowel diseases (IBD). There is a lack of practical and effective interventions to improve adherence. This study aimed to identify modifiable risk factors, which may yield targets for new interventions.

Methods: Participants with IBD were recruited from hospital outpatient clinics and office-based gastroenterologists. Demographic and disease-related data were recorded by means of self-administered questionnaires. Modifiable risk factors were assessed with the validated Belief about Medicine Questionnaire, Hospital Anxiety and Depression Score, and short inflammatory bowel disease questionnaire. Adherence was assessed separately for 5-aminosalicylates, thiopurines, and biological agents using the validated Medicine Adherence Report Scale (good adherence defined as >16).

Results: Nonadherence occurred in 102 of 356 participants (28.7%). Adherence increased significantly with more aggressive therapies (median Medicine Adherence Report Scale: 5-aminosalicylates 18, thiopurines 19, biological 20; P < 0.0001). Nonadherence was not associated with anxiety and depression or disease-related patient knowledge. Adherent patients had significantly higher belief of necessity for medication (P < 0.0001) and a trend toward lower concerns about medication (P = 0.08). Membership of an IBD patient organization was associated with better adherence (P < 0.0001). Concerns about medication rose significantly with more aggressive therapies (P = 0.009), but belief of necessity was similar for all medications.

Conclusions: Nonadherence occurs most frequently with 5-aminosalicylates. Belief of necessity may prove the key target for future interventions, although general IBD education is unlikely to yield an adherence benefit. Patient organization membership should be encouraged.

Article first published online 30 July 2013

*Gastroenterology and Liver Services, Concord Hospital and Bankstown Hospital, Sydney, Australia;

School of Translational Medicine, University of Manchester, United Kingdom;

Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom;

§Department of Gastroenterology, Royal Albert Edward Infirmary, Wigan, Lancashire, United Kingdom; and

Faculty of Medicine, University of New South Wales, Sydney, Australia.

Reprints: Christian P. Selinger, MD, MSc, Gastroenterology, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, United Kingdom (e-mail:

C. P. Selinger has received research grants from Ferring and Nycomed, and Shire. P. Katelaris has served as a speaker, a consultant, and an advisory board member for AstraZeneca, Janssen, and Orphan Australia. J. Eaden has served as a speaker, a consultant, and an advisory board member for Tillotts, Ferring, Schering Plough. S. Lal has served as a speaker, a consultant, and an advisory board member for IBD/Nutrition companies including Baxter, Ferring, Warner-Chilcott, Shire, and MSD and has received research funding from Crohn's Colitis UK and Raynaud’s and Scleroderma Association. J. McLaughlin has served as an advisory board member for Shire and Almirall. R. W. Leong has served as a speaker for Abbott Australasia and Ferring Pharmaceuticals; an advisory board member for Abbott Australasia, Janssen Cilag Pty Ltd, and Ferring Pharmaceuticals; and has received research funding from Nycomed’s unrestricted grant. A. Robinson is a speaker/consultant for and on the advisory board for Procter and Gamble, Warner Chilcott, Ferring, Falk, and Chiesi.

Received April 11, 2013

Accepted June 03, 2013

© Crohn's & Colitis Foundation of America, Inc.
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