N005 Adherence to outpatient follow-up visit in inflammatory bowel disease patients
M.G. Vettorato*, G. Lorenzon, S. Bellia, A. Rigo, O. Bartolo, G. Girardin, F. Simonetti, R. D’Incà, G. C. Sturniolo, E. V. Savarino
University of Padua, Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy, Padua, Italy
Inflammatory bowel disease (IBD) comprises chronic relapsing-remitting medical conditions requiring lifelong treatment. Non-adherence to treatment has been shown to be detrimental because it has been demonstrated to increase the rate of relapses during the disease course. Data on non-adherence to outpatient follow-up are lacking, as are data on the influence of non-adherence to outpatient follow-up on chronic drugs assumption. Our aim was to evaluate factors that modulate non-adherence to outpatient follow-up in IBD patients.
In total, 250 non-adherent to outpatient visit IBD patients (non-adherent patients, NAP) for 2 years were identified and compared with 132 patients in regular follow-up. A phone interview was administered to participants, investigating epidemiological and organisational aspects, clinical data on disease activity, and adherence to medical therapy using the Morisky scale (MMS8) score < 6 = low; 6–7 = moderate; and 8 = high adherence. In NAP group, we evaluated quality-of-care perception and the reasons for non-adherence to scheduled visits.
We included 250 non-adherent patients (NAP, 137 M/113 F; mean age 49.9 ± 26.5years) and 132 (76M/56F; mean age 41.72 ± 12.92 years) adherent patients (AP). Out of 250 NAP, 136 (45.6%) were authentic non-adherent patients (NAP-A), whereas 114 (36.8%) were found false negative non-adherent patients because they were in follow-up in a peripheral centre (NAP-B). In NAP-A, 97% were poorly symptomatic, 10.8% followed other treatment plan, 6.8% reported social related reasons for non-adherence. NAP-B patients preferred peripheral centre for similar care and shorter waiting list (44%), for logistic reasons (34%), or for a more familiar approach (22%. Most of NAP-A patients had UC (59.6%), whereas AD and NAP-B had more frequently CD (57.6% and 46.5%, p < 0.05). Concerning UC, NAP-A were older (51.12 ± 15.1 years) than NAP-B and AD (46.18 ± 17.87 and 44.30 ± 13.86 years, p < 0.05) were. NAP-A patients had lower educational level than AD patients had (primary education 47.8% vs 26.8%; p < 0.05).Therefore, NAP-A CD patients were older than AD patients (46.59 ± 14.44 years vs 39.82 ± 12.00, p < 0.05), but no differences were found in other epidemiological-disease features. MMS8 showed a low adherence to therapy (< 6) in 59.6% of NAP-A patients and 63.2% of NAP-B patients, whereas 50% of AD patients had a MMS8 > 7 (p < 0.05). However, no differences in disease activity was found.
NAP are most likely UC patients and older than 50 years. High prevalence of non-adherence to therapy was found amongst patients not attending regular follow-up visits. Non-adherence to follow-up was strictly related to low adherence to either therapy. Our data emphasise the need of reinforcing adherence to outpatient follow-up to improve the adherence to therapy, as well as the disease outcome.