Search in the Abstract Database

Search Abstracts 2011

* = Presenting author

P194. Adherence to medical treatment in children with inflammatory bowel disease: A paired patient–parent study

B. Weiss1, N. Zevit2, V. Nachmias-Fridler1, R. Shamir2, Y. Bujanover1

1Edmond and Lily Safra Children's Hospital, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Schnieder Children's Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Aim: To evaluate the frequency of medication nonadherence in children with inflammatory bowel diseases (IBD), and to identify risk factors for nonadherence among patients and their parents.

Methods: Patients with an established diagnosis of IBD for at least 6 months, age 10–20 years, and the accompanying parent, answered each a separate questionnaire during their clinic visit. The questionnaires were anonymous, and when completed were paired into a sealed envelope. The questionnaires (modified from D'inca et al, APT 2008;27:166–172) included 19 and 24 items for patients and parents, respectively, including the following categories: demographic data, disease type, medications – type, schedule, adherence and reasons for nonadherence, communication about the disease, hobbies, parental information – medical screening, medication use, education, profession.

In order to identify predictors associated with nonadherence, bivariate analysis using the χ2 test of association for categorical variables and t tests for continuous variables was conducted. Agreement between parent and child was assessed using a McNemar test. Multiple logistic regression analysis was used to adjust the predictors associated to nonadherence. Reported p values are two-tailed. Analyses were conducted with SAS 6.1.2 (SAS Institute, Cary, NC).

Results: 80 consecutive patients/parent questionnaires [46 (57.5%) males] were included: 61 had Crohn's disease, 16 UC and 2 indeterminate IBD. The means and SDof age and age of diagnosis were 15.24±3.11 and 10.40±4.14 years, respectively. Complete adherence to medications was reported by 60% of the patients and 74% of their parents (NS). In 12 patients (15%) there was disagreement between parent and child, with parents under estimating nonadherence (p = 0.004). Risk factors for medication nonadherence were: patient's age >16 years (p = 0.01), the need to take medications in the evening (p = 0.03), and lack of communication of the child about his/her disease (p = 0.001). In multiple logistic regression, Odds ratio was 4.1 (95% CI 1.4–11.4, p = 0.008)) for nonadherence at age >16 vs. age ≤16 years, and 5 (95% CI 1.5–16.7, p = 0.009) if the child never or almost never talks about the disease. The main reason for nonadherence was forgetfulness, followed by medication side effects. Oral steroids and nutritional treatment had the highest adherence rates, possibly reflecting higher adherence during active disease.

Conclusions: Nonadherence to medications in pediatric IBD patients is 40% in the current study, similar to previous studies. A significant number of parents are not aware to treatment nonadherence of their children. Adolescent patients older than 16 years and patients who do not communicate about their disease are at increased risk for nonadherence. Preventive measures, such as age-specific support groups and better doctor-patient interaction are needed to reduce nonadherence rates in children with IBD.