Inflammatory Bowel Diseases

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Inflammatory Bowel Diseases:
doi: 10.1097/MIB.0b013e31829ed8a6
Original Clinical Articles

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

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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.

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

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