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P154 Identifying predictors of low adherence in patients with Inflammatory Bowel Disease

S. Coenen1, E. Weyts*1, V. Ballet1, M. Noman1, G. Van Assche1, S. Vermeire1, J. Vanemelen2, M. Ferrante1

1UZ Leuven, Gastroenterology, Leuven, Belgium, 2MACX , Integrated Care, Aartselaar, Belgium

Background

Inflammatory Bowel Diseases (IBD) are chronic gastrointestinal conditions that often require medical therapy. However, medication can be costly, difficult to take or associated with unpleasant side effects. This may result into less optimal adherence and, consequently, poorer disease outcome. Therefore, identifying predictors of low adherence is paramount to effectively intervene and increase the adherence and outcome of IBD patients.

Methods

Between November 2013 and March 2014, 471 ambulatory IBD patients in our tertiary referral center were requested to complete the Morisky 8-Item medication adherence questionnaire (MMAS-8) as well as a survey containing socio-demographic data (smoking, educational level, marital status and occupation). Based on the self-reported MMAS-8, adherence was categorized as low (MMAS-8 score >2), medium (1-2) or high (0). Using SPSS 22.0, we looked for factors independently associated with low adherence.

Results

Data were collected for 466 IBD patients (50% male, median age 41 years, 71% Crohn's disease, 29% ulcerative colitis), giving a participation rate of 99%. Univariate analysis in the IBD group showed that mesalamine was the only therapy associated with low compliance [1.572 (1.032-2.395), p=0.035]. As regards occupation, low adherence was most frequently observed in students (47.6%) and employees (42.0%), and less frequently in the self-employed (20.0%). Other significant predictors of low adherence were higher educational level and being single. In multivariate analysis, factors independently associated with low adherence were higher educational level [1.867 (1.315-2.650), p<0.001], being single [1.724 (1.147-2.590), p=0.009], and being self-employed [0.348 (0.156-0.774), p=0.010]. IBD patients who felt worse had more difficulty sticking to the treatment plan [39.1% vs. 19.5%, OR 2.652 (1.092-6.437), p=0.026] and they concealed their doctor about this [21.7% vs. 8.7%, OR 2.911 (0.996-8.507), p=0.042].Patients with a higher educational level reported that they forgot more often to take their medication [35.2% vs. 17.8%, OR 2.513 (1.638-3.855), p<0.001] and they stopped the intake of their medication more often when they felt well [20.9% vs. 12.6%, OR 1.836 (1.116-3.020), p=0.016]. As regards occupation, students had more difficulties sticking to the treatment plan [35.9% vs. 21.5%, OR 2.047 (1.030-4.067), p=0.037].

Conclusion

Approximately one third of the IBD patients were low adherers. Predictors of low adherence in this group were higher educational level, being single, and not being self-employed. More data are warranted to define a well-validated profile for IBD patients with low medication adherence requiring a tailored intervention.