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P555 Adherence to medical therapy and follow up in IBD patients

M.G. Vettorato*1, A. Rigo2, S. Bellia2, G. Brogiato2, F. Simonetti2, R. D'Incà2, G.C. Sturniolo2

1Azienda Ospedaliera, Department of Surgical, Oncological and Gastroenterological Sciences, Padua, Italy, 2Azienda Ospedaliera di Paodva, Department of Sugery, Oncology and Gastroenterology, Padua, Italy

Background

In inflammatory bowel disease (IBD) care non-adherence to out-patient visits can be detrimental for various reasons including the lack of monitoring drug-related side effects, disease progression and complications. The actual focus on adherence is mainly addressed to evaluate optimal therapy assumption.

Methods

Patients selected from our IBD database not referring for regular follow-up visits in the last 24 months have been compared to patients regularly attending the clinic in a ratio 2:1. A structured questionnaire has been administered during a telephone call by the nurse in order to assess: disease activity (Modified Truelove Witts Severity Index - MTWSI in UC, Harvey Bradshaw Index - HBI in CD) and adherence to medical therapy (Morisky-8 scale: < 6 = low adherence, 6-7 = moderate adherence, 8 = high adherence). Statistical analysis included standard error at 95% and odds ratio.

Results

455 patients have been enrolled: 382 ( 54% UC and 46% CD) accepted to answer all the questions, 132 regularly attending patients (75 males - mean age 41.6 yrs ±13) and 250 non-attending patients (137 males, mean age 47.8 yrs± 15.5). Sixty patients did not answer the phone and 13 did not want to answer the questions. Non-adherent patients were more frequently females (OR=1.40 IC=0.83-2.36), age > 55 yrs (OR=4.06 IC =1.77-9.27), with UC (OR=1.71, IC=1.00-2.91) and with disease duration less than 12 months (OR= 2.52, IC 0.88-7.16). The Morisky score was significantly lower in non-adherent than in adherent patients (p= 0.003). Higher risk of non-adherence was found in patients with a Morisky score lower than 6 (OR 3.46 -IC=1.89-6.33) or equal to 8 (OR = 5.75- IR 2.53-13.06), in females (p=0.000), in younger patients (p=0.007) and in CD vs UC (p=0.003). The 30% of non-adherence patients after call by the nurse they accepted to return to out-patient visits.

Conclusion

The majority of the patients did accept positively the telephone call. Patients not-attending regular follow up visits are at high risk of non-adherence to medical therapy as well.

Females, patients older than 55 years, patients with UC and a short disease duration are at higher risk of out-patient non-adherence. Efforts need to be addressed to improve global adherence, included regular attendance of follow up visits. Reinforcement and motivation by the IBD nurse may help to increase patients' empowerment.