P395 Therapeutic adherence in patients with inflammatory bowel disease.
C. Azucena*, B. Nallely, Y.-F. Jesus
IBD Clinic, Instituto Nacional de Ciencias Medicas y Nutricion, Gastroenterology, Mexico, Mexico
Ulcerative Colitis (UC) and Crohn's disease (CD) are subtypes of inflammatory bowel diseases (IBD). Medical treatment is for life to maintain long-term remission in patients with IBD. Previous studies in patients with IBD have shown poor Therapeutic Adherence (TA) with a rate between 30 and 45%. However, there are no studies performed in countries from Latin America that have eval-uated TA in IBD patients. The aim of this study is to evaluate the frequency of adherence in patients with IBD a Third Level Hospital Care and to determine factors associated to TA as well as to identify the most useful survey for evaluating TA in our population.
A cross-sectional study was performed in patients with IBD (UC 82% and CD 19%) between the period March and June 2014. Four questionnaires were applied (Morisky-Green, Haynes-Sackett, Morisky Medication Adherence Scale MMAS-8 and Soria Zaira and Nava UNAM). Descriptive statistics were performed, X2 test, Student's t test and Cohen's Kappa. SPSS version 17 was used.
A total of 130 subjects were evaluated and 28 patients were excluded due to incomplete infor-mation in the questionnaires. In patients with UC, 60% were in clinical remission, endoscopic remis-sion in 13% and 7% in histological remission. In CD 75% were in clinical remission and 55% had ileo-colonic localization. In the Morisky Green's survey identified patients with good TA (47%) have basic education. Hayness-Sackett showed that patients with good adherence were older than 40 years old and had more than 10 years of disease evolution (P=0.05). The MMAS-8 scale showed good adhesion to 19.4%, medium 24.1% and 56.5% low. The factor associated to good adherence was home occupation (P<0.05). The survey Soria-Zaira (UNAM) identified patients that had adher-ence to medical-behavioral activity in 62% 71% in diet and 74% in exercise. We observed that the evaluation of Morisky-Green and Morissky Medication Adherence Scale (MMAS-8) provided a more objective diagnosis of adherence to treatment and had high concordance between them (kap-pa= 0.74; P <0.05). When the adherence was assessed by Zaira Soria-Nava survey, we found a sig-nificant agreement with the classification of MMAS-8 (P <0.05).
The good TA was 47% by Morisky-Green, 86% by Haynes-Sackett, 44% by validated scale for EII (MMAS-8) and 88% by Soria-Zaira UNAM. The factors associated to better adherence treatment were basic education, age in the fourth decade of life, more than 10 years of disease evolution and activities at home.