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P561 Can we predict adherence to treatment in IBD patients?

Naftali T.*1, Ein Dor A.2,3, Ruhimovich N.4, Shitrit A.B.5, Sklerovsky Benjaminov F.2,4, Matalon S.2,3, Shirin H.3,6, Konikoff F.M.1,2, Broide E.3,6

1Meir medical center, Gastroenterology, Kfar Saba, Israel 2Tel Aviv university Sackler school of medicin, internal medicine, Tel Aviv, Israel 3Assaf Harofeh Medical Center, The Kamila Gonczarowski institute of Gastroenterology Assaf Harofeh Medical Center, Zerifin, Israel 4Meir Medical Center, Department of Gastroenterology & Hepatology, Kfar Saba, Israel 5Shaare Zedek Medical Center, Department of Gastroenterology and Digestive Diseases, Jerusalem, Israel 6Tel Aviv university Sackler school of medicin, internal medicine, Tel aviv, Israel

Background

Adherence is generally associated with improved treatment outcome in patients with IBD and is estimated to be between 30–60%. Capturing non adherence in daily practice remains a challenge. Risk factors for non-adherence are still contradictory. The study aimed to identify risk factors for non- adherence in IBD patients

Methods

All participants filled questionnaires including: demographic, clinical, socioeconomic data and accessibility to GI services. Psychological features were assessed using: Sense of Coherence, Hospital Anxiety and Depression Scale, IBD self-efficacy scale and Brief Illness Perception questionnaires. Adherence to treatment was evaluated using the Morisky (8 questions) score.

Results

This study included 224 patients; 64.3% females, median age 37 years (IQR 27–44). Of them 70% had Crohn's disease (CD), 25% Ulcerative colitis (UC) and 5% undetermined colitis. A third of UC and 20% of CD patients had an extensive disease. Seventy percent had at least 1 hospitalization, 33% underwent at least one operation and 50% received biological treatment. Backward multivariate regression analysis demonstrated that high adherence was associated with biological treatment (OR 0.33; 95% CI 0.135–0.784, p=0.012) and depression (OR 0.1; 95% CI 0.26–0.415, p=0.001). Low adherence was associated with anxiety (OR 3.43; 95% CI 1.47–7.98, p=0.004) and past smoking (OR 6.95; 95% CI 1.59–30.42, p=0.010). Marital status and number of medications taken by the patient were not associated with adherence. Type of disease, time from symptoms, age, gender, employment, use of 5-ASA, hospitalization and severity of disease score were associated with adherence in the univariate analysis but not in the multivariate analysis.

Conclusion

Psychological factors (depression or anxiety) as well as disease related factors (biological treatment and smoking status) can strongly influence adherence status in IBD patients.