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P544 Factors associated with drug non-adherence in an Indian IBD patient cohort: It's not always the cost

R. Banerjee1, U. Basavaraju*2, B. Adigopula1, V. Nagalaxmi1, N. Reddy1

1Asian Institute of Gastroenterology, Inflammatory Bowel Disease, Hyderabad, India, 2Aberdeen Royal Infirmary, Nhs Grampian, Digestive Disorders, Aberdeen, United Kingdom

Background

Drug adherence plays an important role in the efficacy of medical management of IBD. Non-adherence to treatment is associated with an increased risk of relapse with consequent morbidity. The barriers to adherence in the developing world have not been evaluated but cost has been implicated. The aim of this study was to evaluate the prevalence of medication non-adherence and identify associated significant demographic, clinical and psychosocial factors in a cohort of IBD patients from India.

Methods

463 consecutive IBD patients, (278 with UC and 185 with CD), mean age 38.6yrs were interviewed by a self-administered questionnaire in the IBD clinic of a large tertiary referral centre. Demographic, clinical, physician and psychosocial related data was recorded. Adherence (A) was assessed using the validated Morisky Medication Adherence Scales (MMAS); non-adherence (NA) was defined MMAS score >3. Statistical analysis was done using Chi-square, T-test and Mann-Whitney U tests. Multivariate logistic regression was performed to identify independent variables that correlated with non-adherence. Measurement of risk associated with NA using odds ratios (OR) was calculated along with 95% CI.

Results

The overall rate of self reported non-adherence was 51% (53% UC and 49% CD). There was no statistically significant difference between A and NA groups in relation to age, gender, marital status, education, employment, disease duration and geographical location. Logistic regression analysis revealed age>50yrs (OR 0.45; 95%CI 0.22-0.93) was associated with NA. Patients in remission (OR 1.73; 95%CI 1.08-2.77) and who were married (OR 2.20; 95%CI 1.15-4.20) were likely to be A to treatment. Large number of concomitant medication use (OR 0.47; 95%CI 0.25-0.88) and non-availability (OR 0.43; 95%CI 0.23-0.80) increased risk of non-adherence. Patients who perceived that IBD medication was expensive (OR 2.03; 95%CI 1.36-3.03) and it protects disease from worsening (OR 1.79; 95%CI 1.10-2.89) were likely to be adherent. Physician re-enforcement of importance of drug adherence increased adherence (OR 2.50; 95%CI 1.20-5.18). Patients who felt that medication disrupts their life (OR 0.34; 95%CI 0.14-0.81) and causes mental disturbance (OR 0.47; 95%CI 0.25-0.87), were at risk of non-adherence. Medication adherence was associated with improved Quality of life score (mean QoL score was 5.0 in A and 4.7 in NA groups, p=0.001).

Conclusion

Non adherence is common in Indian IBD patients. Adherence was associated with disease remission and improved QoL. Cost of medication does not appear to be the major factor for non adherence. The identified predictive factors should be explored to improve adherence to therapy of IBD and improve patient outcomes.