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P767 Non-adherence behaviours of patients with inflammatory bowel disease and other chronic conditions. Relationship with experience with healthcare and beliefs in medications

I. Marín-Jiménez*1, D. Orozco-Beltrán2, J. Toro3, M. J. Galindo4, B. Juliá5, L. Cea-Calvo6

1Hospital Universitario Gregorio Marañón, Gastroenterology, Madrid, Spain, 2Miguel Hernández University, Medicine, Sant Joan, Alicante, Spain, 3Hospital Universitario A Coruña, Universidade da Coruña, INIBIC, Rheumatology, A Coruña, Spain, 4Clinic University Hospital, Internal Medicine, Valencia, Spain, 5Medical Affairs, Merck Sharp & Dohme, Madrid, Spain, 6Medical Affairs, Merck Sharp & Dohme, Spain, Madrid, Spain

Background

We describe the frequency of non-adherence behaviours of patients with four different chronic conditions, and the potential influence of their healthcare experience and beliefs in medications.

Methods

A survey was handed to patients with inflammatory bowel disease (IBD), rheumatic diseases (RD), Human Immunodeficiency Virus (HIV) infection or diabetes mellitus (DM). Five non-adherence behaviours were defined: 1) Forgiveness in taking medication; (2) Taking medication at unscheduled hours; (3) Leaving medication if feeling well; (4) Leaving medication if feeling sick and 5) Stopping medication after reading the patients’ information leaflet. Experience with healthcare was assessed with IEXPAC (‘Instrument to Evaluate the EXperience of PAtients with Chronic diseases’), scoring from 0 (worst) to 10 (best experience), and obtaining subscores for its 3 factors (productive interactions, new relational model, self-management). Beliefs in medicines was assessed with the Beliefs About Medicines Questionnaire (BMQ), obtaining necessity and concerns score, (range 5 to 25) and an overall BMQ score (−20 to +20). Variables associated to nonadherence were studied with multi-variate logistic regression models.

Results

Of 1530 patients (336 with RD, 332 with IBD, 442 with HIV infection, 430 with DM), 813 (53%) had at least one non-adherence behaviour. The frequency was higher in DM patients and lower in patients with HIV infection (RD: 56%, IBD: 56%, HIV infection: 43%, DM: 60%, p < 0.001). It was higher in patients with lower IEXPAC experience scores (Quartile [Q] 1: 62%, Q2: 55%, Q3: 48%, Q4: 47%, p-trend < 0.001) and with lower beliefs score (Q1: 66%, Q2: 63%, Q3: 50%, Q4: 37%, p-trend < 0.001), lower necessity scores or higher concerns score. In multi-variate models (table), non-adherence behaviour was associated to DM and to lower BMQ score. When factors and subscales were introduced, non-adherence was associated to DM, lower self-management IEXPAC score, lower necessity and higher concerns BMQ scores.

Multi-variate analysis. Factors associated to non-adherence behaviours

Conclusion

Non-adherence behaviours are frequent in chronic patients, more in patients with DM, and are associated to experience with healthcare (self-management) and, more significantly, to patients’ beliefs in medications (lower necessity and higher concerns). These aspects must be addressed by clinical teams when dealing with chronic patients to increase medication adherence. The study was Funded by Merck Sharp & Dohme of Spain. Endorsed by patients’ associations ACCU (IBD), CONARTRITIS (arthritis), SEISIDA (AIDS multi-discipline group) and FEDE (DM).