Treatment of Inflammatory Bowel Disease: Is your Patient at Risk of Non-Adherence?

Abstract

Acta Med Port 2014 Sep-Oct;27(5):576-580 RESUMOIntrodução: A adesão à terapêutica é um aspecto chave para a eficácia da terapêutica. O objectivo deste estudo foi avaliar a frequên-cia e factores de risco associados à não adesão à terapêutica na doença inflamatória intestinal. ABSTRACT Introduction:Adherence to therapy is a key factor when analyzing the efficacy of a treatment in clinical practice. The aim of our study was to assess the frequency of non-adherence to treatment among patients with inflammatory bowel disease and evaluate which factors could be related. Material and Methods:One hundred thirty eight consecutive inflammatory bowel disease outpatients (55.8% with Crohn's disease and 44.2% with Ulcerative Colitis) filled in an anonymous questionnaire, which included information about demography, duration of the disease, specific therapy for inflammatory bowel disease, and data possibly related to extent of non-adherence to treatment. Statistics were performed with SPSS v.18.0. Categorical variables were compared with Fisher's exact test. A p value < 0.05 was considered statistically significant. Significant variables in univariate analysis were included in the logistic regression analysis.Results: Overall non-adherence was reported by 29.7% of patients. 70.7% of them reported unintentional non-adherence and 51.2% forgot at least one dose per week. Non-adherence was statistically associated with: short disease duration (p < 0.001); young age (p = 0.001); topical aminosalicylates (p = 0.005); the perception that medical therapy isn't effective enough (p = 0.007) and high educational level (p = 0.011). In a logistic regression analysis, topical aminosalicylates use (p = 0.004), short disease duration (p = 0.006) and young age (p = 0.027) were identified as significant predictors of non-adherence. Discussion: Young patients, patients with short disease duration and under topical aminosalicyates presented a higher risk for nonadherence to treatment. Conclusions: Gastroenterologist's attention should be focused on the identification of risk factors potentially involved in non-adherence to therapy and in the promotion of measures to improve it.

Translation and initial validation of the Medication Adherence Report Scale (MARS) in Italian patients with Crohn’s Disease

“…In previously published studies parameters associated with greater adherence to medical therapy in IBD patients were age, follow-up by a gastroenterologist, and immunosuppressant use [8,9]. Lower rates of treatment adherence were associated with employment status, high scores on the Obstacles to Medication Use Scale, short disease duration, high education level, dissatisfaction with the patient-doctor relationship, mood disorders, and age younger than 40 [7][8][9][10]49]. Moreover, patients' personal beliefs about the IBD and its treatment are important, potentially modifiable, determinants of both adherence and nonadherence [50,51].…”

“…It has been recently demonstrated that non-adherence to prescribed long-term treatment is a major determinant of treatment efficacy in inflammatory bowel disease (IBD) patients and represents a common problem in IBD management in clinical practice. The frequency of non-adherence ranges from 18 to 30% as reported in several recent international trials [7][8][9][10]. In a recent study of potential triggers for IBD flares, which included non-steroidal anti-inflammatory drug use, antibiotic use, stressful life events, cigarette smoking, infections, travel in the preceding 3 months, and medication adherence, only the last one resulted to be significantly associated with flares [11].…”

Investigação sobre adesão à terapêutica na população portuguesa: uma revisão de âmbito

“…Com a exceção do estudo de Margalho e colaboradores, 27 todos os estudos têm âmbito regional ou local: sete na região Norte, 26,[32][33]36,[41][42]49 sete na região de Lisboa e Vale do Tejo, 28,30,34,40,[43][44]48 quatro na região Centro, 25,35,45,51 dois no Alentejo 31,37 e dois no Algarve. 29,50 Em dois dos estudos não é clara a região do País onde os mesmos decorreram; [38][39] também o estudo de Reis 24 decorreu simultaneamente num hospital de Lisboa e num hospital do Porto.…”

“…Dos estudos selecionados, em 15 a amostra foi obtida a partir de utentes seguidos em consultas hospitalares de especialidade; [24][25][26][27]29,[32][33][34][35][38][39][42][43]48,51 em seis estudos, 28,31,[36][37]41,49 a partir de utentes seguidos nos cuidados de saúde primários -desde uma Unidade de Saúde Familiar no estudo de Chin e colaboradores 28 até à Administração Regional de Saúde do Alentejo, no estudo de Moita; 31 dois estudos recorreram a utentes de farmácias comunitárias; 30,45 em dois estudos, a amostra foi constituída por utilizadores de centros de dia 44,50 e, no último, por utentes seguidos na Associação Protetora dos Diabéticos de Portugal. 40…”

“…29 De referir, no entanto, que este período correspondeu, na maioria dos estudos, ao período de recrutamento dos doentes, sendo o período de análise da adesão à terapêutica propriamente dita consideravelmente menor. Em nove estudos, 32,[38][39][41][42][43][49][50][51] essa informação é omissa.…”