Improving maintenance medication adherence in adult inflammatory bowel disease patients: a pilot study

Abstract

Medication nonadherence in inflammatory bowel disease (IBD) may lead to suboptimal control of the disease, decreased quality of life, and poor outcomes. This pilot study evaluated the feasibility, intervention mechanism, and potential effectiveness of a three-month continuous self-improvement (CSI) intervention to enhance medication adherence (MA) in adult nonadherent IBD patients. Adult IBD patients taking a daily or twice-daily dosed maintenance medication were screened electronically for two months to determine baseline MA levels. Nonadherent IBD participants were randomized to the CSI or the attention control (AC) intervention and monitored for three months. The CSI intervention consisted of a data evaluation and system refinement process in which system changes were identified and implemented. The AC group was given educational information regarding IBD disease process, extra-intestinal manifestations of IBD, and medical therapy. Demographic statistics, change scores for within and between-group differences, and effect size estimates were calculated. Nine nonadherent participants (medication adherence score <0.85) were eligible for randomization. The intervention was found feasible and acceptable. Although no statistically significant improvement in MA was found (P=0.14), adherence improved in 3 of 4 of the CSI group and 1 of 2 in the attention control group. The effect size calculation of 1.9 will determine the sample size for future study. The results of this pilot study showed the intervention was feasible and had a positive effect on MA change score and adherence levels. A larger fully powered study is needed to test of the effectiveness of this innovative intervention.

Effect of electronic adherence monitoring on adherence and outcomes in chronic conditions: A systematic review and meta-analysis

“…Table 1 describes the main characteristics of the studies. Study population size ranged from 6 [ 26 ] to 784 [ 14 ] participants (mean = 128, median = 80). Most (n = 41, 87%) were in adults with only 6 studies in children.…”

“…The most common EAM device type was an electronic cap fitted onto an oral medication bottle (the ‘Medication Event Monitoring System (MEMS)‘ (n = 14, 30%) [ 26 , 37 , 39 , 40 , 42 , 43 , 47 , 48 , 50 – 55 ] or similar (n = 10, 21%) [ 38 , 41 , 46 , 49 , 56 – 61 ]. The four (9%) other studies of oral medicines used electronic medication blister cards [ 14 , 62 – 64 ].…”

“…Table 3 shows the effects of EAM on clinical outcomes across the 47 included studies summarised narratively. Nine studies (19%) did not assess clinical effect [ 26 , 38 , 54 – 57 , 65 , 66 , 68 ]–most these (7/9) were of a shorter study duration (six months or less). There were 38 (81%) studies that reported clinical outcomes; ten (26%) reported statistically significant improvements [ 27 , 28 , 30 , 32 , 37 , 39 , 46 , 47 , 52 , 62 ].…”

What Do We Know about Medication Adherence Interventions in Inflammatory Bowel Disease, Multiple Sclerosis and Rheumatoid Arthritis? A Scoping Review of Randomised Controlled Trials

“…Eight studies showed no significant effect on medication adherence, 36,46,52,53,55,56,63,65 but two of these were pilot studies only. 52,55 These varied across length of intervention from 15 minutes 63 to 12 months 36,46,[64][65][66] and follow-up from 1 month 63 to 14 months.…”

“…[71][72][73][74][75][76] Objective physiological measures (blood and urine tests), calendars and diaries were less commonly used, and almost half the studies used a combination of methods to measure adherence. 4,51,[54][55][56][57][58][59][60][61]64,68…”