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P498 Rephrasing the question: a novel simple tool for a more accurate evaluation of inflammatory bowel disease patients’ adherence to therapy

T. Engel*1, G. Ben-Haim2, N. Levhar1, R. Eliakim1, S. Ben-Horin1

1Sheba Medical Centre Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Gastroenterology, Ramat Gan, Israel, 2Sheba Medical Centre Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Internal Medicine C, Ramat Gan, Israel

Background

Nonadherence with medication in patients with inflammatory bowel disease (IBD) is a challenging problem with multiple causes, which is often overlooked or under-estimated by the physician. We aimed to examine if rephrasing the wording of the question used by the physician could help in revealing more patients who are non-adherent and for whom appropriate counselling may be instituted.

Methods

This was cross-sectional questionnaire-based study of IBD patients treated in a tertiary centre. Patients received a questionnaire detailing their treatments and disease course, as well as perceptions about disease. Two forms of questions about adherence were deliberately placed in 2 separate parts of the questionnaire: One was ‘Are you taking your medications regularly as prescribed?’ (Standard question), and the second, more emphatic question was ‘How often does it happen that you miss a drug dosing?’ (rephrased question). The rate of non-adherence disclosed by each of these questions was compared, and was conventionally defined as taking less than 80% of prescribed medication doses. Predictors of non-compliance and of denying non-compliance were also explored.

Results

We recruited 165 patients (49% female, mean age 33.7 ± 12.7 SD, 29.6% with UC, 62.4% with CD). Of these, 26.6% were on 5-aminosalicylic acid; 43% on an immunomodulator; and 49% on biologic agent. Further, 51% of the patients were taking a single medication. Upon questioning, 50 of the patients admitted to non-adherence in the last month when asked by the emphatic rephrased question format, compared with only 10 patients admitting to non-adherence when asked directly by the standard question (OR 7.4, 95%CI 3.61–5.2, p < 0.001). This implied that asking ‘Do you take your medicine regularly?’ is a question format that disclosed only 20 % of genuinely non-compliant patients. In fact, as compared with rephrased question wording, the first more standard question had 16% sensitivity and 98.2% specificity for revealing non-adherence (PPV 80% and NPV 72.9%). The leading cause for nonadherence was vacation or weekend (15%), followed by problems with prescription or pharmacy (13.5%) and forgetfulness (10%). No single demographic or disease-related factor correlated with nonadherence behaviour. The only factor correlated with higher probability for non-adherence was biological and combination treatment

Conclusion

Non-adherence to treatment is much more common than patients admit. Asking patients how many times they forgot or skipped medication is a simple practical tool which performs significantly better in disclosing non-adherence compared with asking patients if they take their medication as they should.