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N007. Survey of factors determining adherence to follow up in IBD patients

M.G. Vettorato1, S. Bellia1, G. Brogiato1, R. Zanotti2, R. D'Incà1, G.C. Sturniolo1, 1Azienda Ospedaliera, Department of Surgical, Oncological and Gastroenterological Sciences, Padua, Italy, 2University of Padua, Department of Environmental Medicine and Public Health, Padua, Italy

Background

Improvement of patients' adherence is crucial in IBD as non-adherence anticipates an increased risk of relapse. Most of the efforts have been dedicated to unravel factors determining suboptimal adherence to therapy. However, adherence can be interpreted more broadly as involving the whole process of care. We interviewed all patients participating in our registry who did not adhere to follow up visits aiming to know factors determining non-adherence, to increase awareness on the need for follow up.

Methods

A structured telephone interview was performed by our research nurse to patients participating in our registry who did not attend the clinic in the last 12 months. The registry includes 485 patients (52% UC, 43% CD, 5% U-IBD).

Results

Among 110 patients, 67 agreed to answer the nurse's questions, 12 declared to be followed by another specialist, 4 patients have died and 27 could not be reached. The interview allowed to score disease activity using the modified Truelove Witts severity index (MTWSI) in ulcerative colitis (UC) and the Harvey–Bradshaw Index (HBI) for Crohn's disease (CD). Adherence to therapy was investigated using the Morisky scale and adherence scored from 1 to 8 (score <6 = low adherence, 6–7 = moderate adherence, 8 = high adherence). Reasons for non-adherence to the prescribed visits were investigated.

Among the 67 (40 male, 27 female) interviewed patients (mean age 47.8±15.3 years) 54% had UC and 46% had CD. 74% of UC patients and 79% of CD patients were in clinical remission. Reasons for non-adherence to the scheduled visits were feeling well 36%, difficulties in communicating with the Unit/waiting list/time waited to be visited 30%, being happy with the general practitioner 15%, personal difficulties 8%, self-cure 6%, refusal of conventional medicine 5%. Quality of care at the IBD Unit was perceived adequate in 60 patients. Adherence to therapy was low in 61%, moderate in 22% and high in 17%of the patients. Females were less adherent than males (p = 0.047). All patients appreciated the telephone call and accepted the invitation to re-enter the follow up programme.

Conclusion

High prevalence of non-adherence to therapy was found among patients not attending regular follow up visits. The majority of non-adherent patients were in remission. Efforts need to be addressed to improve quality of the clinical environment. Telephone reinforcement and motivation by the IBD nurse may help in patients' empowerment.