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P255. E-mail reminders and adherence rates to medical treatment in patients with inflammatory bowel disease

A. Hernandez Camba1, M. Carrillo1, L. Ramos1, I. Alonso1, N. Hernandez Alvarez-Buylla1, O. Alarcon Fernandez1, A. Jimenez Sosa2, E. Quintero1, 1Hospital Universitario de Canaris, Gastroenterology, La Laguna, Spain, 2Hospital Universitario de Canaris, Research Unit, La Laguna, Spain

Background

Non-adherence to medical treatment in patients with inflammatory bowel disease (IBD) is a well known fact and it is associated with an increased risk of relapse and health care costs. Usefulness of e-mail reminders to improve patient compliance has not been reported previously.

Methods

We performed a prospective study at the Hospital Universitario de Canarias. Patients with IBD diagnosed at least 6 months before, 18 y or older were included. We excluded patients on steroids, pregnant women and those unable to sign the informed consent. Demographic data, including Internet use, were registered. Medical data (years from diagnosis, type and extension of IBD, medication, related surgery, Mayo or CDAI index and a quality of life questionnaire) were also recorded. Adherence to medical treatment was determined with a previously validated questionnaire. We included three groups of patients: group A Internet non users, group B Internet users without e-mail reminders and group C Internet users with e-mail reminders. Non Internet users were followed as usual. Patients in the Internet group users were randomized to standard follow-up appointments plus periodic e-mail reminders or just to regular follow-up consultations. Adherence was determined at the beginning of the study and at six and twelve months.

Results

From June 2011 to November 2011, 168 patients were included (79% F) and followed for one year. 86 had ulcerative colitis, 79 Crohn's disease and 3 indeterminate colitis. 131 patients (78%) were Internet users and 37 not users. 61 Internet users were randomized to the e-mail remainder group. Initial global adherence was 34.3% in group A, 27.8% in group B and 26.2% in group C (p = n.s). At the end of the study, global adherence rates were 83.3% in group A, 71.8% in group B and 73.2% in group C (p = n.s). When analyzing the subtype of non-adherence we did not find either any difference between groups. There were no differences between groups regarding complications, need to change to steroids or biological therapy, surgery, hospitalizations or any other complication. CDAI, Mayo and quality of life scores were similar between the three groups at the end of the follow-up.

Conclusion

The use of e-mail reminders do not improve adherence to medical treatment in patients with IBD when compared with standard follow-up. Regular follow up with appropriate medical information seems to be enough to improve the adherence rate in IBD patients.