1
|
Marshall MR, Curd S, Kennedy J, Khatri D, Lee S, Pireva K, Taule’alo O, Tiavale-Moore P, Wolley MJ, Ma TM, Kam AL, Suh JS, Aspden TJ. Structural Equation Modelling to Identify Psychometric Determinants of Medication Adherence in a Survey of Kidney Dialysis Patients. Patient Prefer Adherence 2024; 18:855-878. [PMID: 38645697 PMCID: PMC11032681 DOI: 10.2147/ppa.s454248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Medication non-adherence in dialysis patients is associated with increased mortality and higher healthcare costs. We assessed whether medication adherence is influenced by specific psychometric constructs measuring beliefs about the necessity for medication and concerns about them. We also tested whether medication knowledge, health literacy, and illness perceptions influenced this relationship. Patients and Methods This study is based on data from a cross-sectional in-person questionnaire, administered to a random sample of all adult dialysis patients at a teaching hospital. The main outcome was self-assessed medication adherence (8-Item Morisky Medication Adherence Scale). The predictors were: concerns about medications and necessity for medication (Beliefs About Medication Questionnaire); health literacy; medication knowledge (Medication Knowledge Evaluation Tool); cognitive, emotional, and comprehensibility Illness perceptions (Brief Illness Perception Questionnaire). Path analysis was performed using structural equations in both covariance and variance-based models. Results Necessity for medication increased (standardized path coefficient [β] 0.30 [95% CI 0.05, 0.54]) and concerns about medication decreased (standardized β -0.33 [-0.57, -0.09]) medication adherence, explaining most of the variance in outcome (r2=0.95). Medication knowledge and cognitive illness perceptions had no effects on medication adherence, either directly or indirectly. Higher health literacy, greater illness comprehension, and a more positive emotional view of their illness had medium-to-large sized effects in increasing medication adherence. These were indirect rather and direct effects mediated by decreases in concerns about medications (standardized β respectively -0.40 [-0.63,-0.16], -0.60 [-0.85, -0.34], -0.33 [-0.52, -0.13]). Conclusion Interventions that reduce patients' concerns about their medications are likely to improve adherence, rather than interventions that increase patients' perceived necessity for medication. Improving patients' general health literacy and facilitating a better understanding and more positive perception of the illness can probably achieve this. Our study is potentially limited by a lack of generalizability outside of the population and setting in which it was conducted.
Collapse
Affiliation(s)
- Mark R Marshall
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Medicine, Tauranga Hospital, Hauora a Toi Bay of Plenty, Tauranga, New Zealand
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Samantha Curd
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julia Kennedy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dharni Khatri
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sophia Lee
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Krenare Pireva
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Olita Taule’alo
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Porsche Tiavale-Moore
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Wolley
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
- Department of Nephrology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Tian M Ma
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Institute for Innovation + Improvement, North Shore Hospital, Auckland, New Zealand
| | - Angela L Kam
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Barts Health NHS Trust, London, UK
| | - Jun S Suh
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Trudi J Aspden
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Srinivasan AR. Treat to target in Crohn's disease: A practical guide for clinicians. World J Gastroenterol 2024; 30:50-69. [PMID: 38293329 PMCID: PMC10823901 DOI: 10.3748/wjg.v30.i1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
A treat-to-target (T2T) approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE)-II guidelines specify short, intermediate, and long-term treatment goals, documenting specific treatment targets to be achieved at each of these timepoints. Scheduled appraisal of Crohn's disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified. Consensus treatment targets in Crohn's disease comprise combination clinical and patient-reported outcome remission, in conjunction with biomarker normalisation and endoscopic healing. Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing, clinicians must consider that this may not always be appropriate, acceptable, or achievable in all patients. This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets. The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques, particularly intestinal ultrasound, holds great promise; as do emerging treatment targets such as transmural healing. Two randomised clinical trials, namely, CALM and STARDUST, have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn's disease. Findings from these studies reflect that patient subgroups and Crohn's disease characteristics likely to benefit most from a T2T approach, remain to be clarified. Moreover, outside of clinical trials, data pertaining to the real-world effectiveness of a T2T approach remains scare, highlighting the need for pragmatic real-world studies. Despite the obvious promise of a T2T approach, a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake. This highlights the need to describe strategies, processes, and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice. Hence, this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn's disease.
Collapse
Affiliation(s)
- Ashish R Srinivasan
- Department of Gastroenterology, Austin Health, Victoria, Melbourne 3083, Australia
- Department of Gastroenterology, Eastern Health, Victoria, Melbourne 3128, Australia
- Department of Medicine, University of Melbourne, Victoria, Melbourne 3052, Australia
| |
Collapse
|
3
|
Gravina AG, Pellegrino R, Palladino G, Mazzarella C, Federico P, Arboretto G, D’Onofrio R, Olivieri S, Zagaria G, Durante T, Federico A. Targeting the gut-brain axis for therapeutic adherence in patients with inflammatory bowel disease: a review on the role of psychotherapy. BRAIN-APPARATUS COMMUNICATION: A JOURNAL OF BACOMICS 2023. [DOI: https:/doi.org/10.1080/27706710.2023.2181101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Antonietta Gerarda Gravina
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| | - Raffaele Pellegrino
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| | - Giovanna Palladino
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| | - Chiara Mazzarella
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| | | | - Giusi Arboretto
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| | - Rossella D’Onofrio
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| | - Simone Olivieri
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| | - Giuseppe Zagaria
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| | - Tommaso Durante
- Mental Health Department, S. Pio Hospital, via dell’Angelo, Benevento, Italy
| | - Alessandro Federico
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio, Naples, Italy
| |
Collapse
|
4
|
King K, McGuinness S, Watson N, Norton C, Chalder T, Czuber-Dochan W. What Do We Know about Medication Adherence Interventions in Inflammatory Bowel Disease, Multiple Sclerosis and Rheumatoid Arthritis? A Scoping Review of Randomised Controlled Trials. Patient Prefer Adherence 2023; 17:3265-3303. [PMID: 38111690 PMCID: PMC10725835 DOI: 10.2147/ppa.s424024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose Between 53% and 75% of people with inflammatory bowel disease, 30%-80% with rheumatoid arthritis, and up to 50% with multiple sclerosis do not take medications as prescribed to maintain remission. This scoping review aimed to identify effective adherence interventions for inflammatory bowel disease, but with few studies found, multiple sclerosis and rheumatoid arthritis were included to learn lessons from other conditions. Methods Full and pilot randomised controlled trials testing medication adherence interventions for inflammatory bowel disease, multiple sclerosis, and rheumatoid arthritis conducted between 2012 and 2021 were identified in six electronic databases. Results A total of 3024 participants were included from 24 randomised controlled trials: 10 pilot and 14 full studies. Eight investigated inflammatory bowel disease, 12 rheumatoid arthritis, and four multiple sclerosis. Nine studies (37.5%) reported significantly improved medication adherence, all involving tailored, personalised education, advice or counselling by trained health professionals, with five delivered face-to-face and 1:1. Quality of effective interventions was mixed: five rated high quality, two medium and two low quality. Interventions predominantly using technology were likely to be most effective. Secondary tools, such as diaries, calendars and advice sheets, were also efficient in increasing adherence. Only 10 interventions were based on an adherence theory, of which four significantly improved adherence. Conclusion Tailored, face-to-face, 1:1 interactions with healthcare professionals were successful at providing personalised adherence support. Accessible, user-friendly technology-based tools supported by calendars and reminders effectively enhanced adherence. Key components of effective interventions should be evaluated and integrated further into clinical practice if viable, whilst being tailored to inflammatory conditions.
Collapse
Affiliation(s)
- Kathryn King
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Serena McGuinness
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Natalie Watson
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| |
Collapse
|
5
|
Hadavandsiri F, Khalili D, Mahdavi A, Afkar M, Ostovar A, Hashemi-Nazari SS, Derakhshan S. Timely referral to health centers for the prevention of cardiovascular diseases: IraPEN national program. Front Public Health 2023; 11:1098312. [PMID: 37809007 PMCID: PMC10556464 DOI: 10.3389/fpubh.2023.1098312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/21/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction The IraPEN program is an adapted version of the WHO-PEN program designed to prevent four major non-communicable diseases in Iran. This study aimed to determine the rate of compliance and related factors among individuals participating in the IraPEN program for the prevention of cardiovascular disease. Method In this study, compliance was defined as timely referral to the health center as scheduled, and the researchers approached four pilot sites of IraPEN from March 2016 to March 2018. Sex-stratified logistic regressions were applied to investigate factors related to compliance. However, it is important to note that in this study, compliance was defined as compliance to revisit, not compliance to taking prescribed medications or behavioral lifestyle changes. Results The total compliance rate, including timely compliance and early and late compliance, was 16.5% in men and 23.3% in women. The study found that cardiovascular risk factors such as diabetes, hypertension, hypercholesterolemia, and being underweight were associated with lower compliance. The higher calculated risk of CVD was associated with higher compliance, but after adjusting for cardiovascular risk factors, high-risk individuals showed lower compliance. There was negligible interaction between sex and other factors for compliance. Conclusion The compliance rate with scheduled programs for cardiovascular preventive strategies was very low, and high-risk individuals were less compliant, regardless of their high level of risk factors. The study recommends further training to increase awareness and knowledge regarding the IraPEN program and the prevention of non-communicable diseases among high-risk populations.
Collapse
Affiliation(s)
- Fatemeh Hadavandsiri
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mahdavi
- Center for Noncommunicable Disease Control and Prevention, Ministry of Health (MOH), Tehran, Iran
| | - Mehdi Afkar
- Community Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Saeed Hashemi-Nazari
- Prevention of Cardiovascular Disease Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Derakhshan
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Poor Adherence to Medical and Dietary Treatments in Adult Patients With Eosinophilic Esophagitis. Am J Gastroenterol 2022; 117:1412-1418. [PMID: 35973155 DOI: 10.14309/ajg.0000000000001850] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/31/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To investigate the adherence to prescribed medical and dietary maintenance treatments in a cohort of adult patients with eosinophilic esophagitis (EoE) and to identify associated factors. METHODS In this cross-sectional study, adult patients with EoE who were prescribed medical or dietary maintenance therapy were included. Patients were asked to complete questionnaires concerning treatment adherence (Medication Adherence Rating Scale), beliefs about treatment (Beliefs about Medicine Questionnaire), beliefs about disease (Illness Perception Questionnaire), and current symptoms (Straumann Dysphagia Index). RESULTS A total of 177 patients with EoE (71% males) were included, with a median age of 43 years. The overall prevalence of poor adherence to prescribed treatments (Medication Adherence Rating Scale < 21 or Diet Adherence Rating Scale < 21) in this cohort was high, being 41.8%. Medically treated patients seemed less adherent to prescribed treatment compared with patients prescribed a diet (35.1% vs 41.8%, P = 0.320). Multivariate logistic regression analyses identified the following independent factors associated with poor treatment adherence: age <40 years (odds ratio [OR] 2.571, 95% CI 1.195-5.532, P = 0.016), longer disease duration in years (OR 1.130, 95% CI 1.014-1.258, P = 0.027), severe symptoms (Straumann Dysphagia Index) (OR 1.167, 95% CI 1.012-1.345, P = 0.034), and low necessity beliefs (OR 4.423, 95% CI 2.169-9.016, P < 0.001). DISCUSSION Adherence to maintenance treatment is poor in many adult patients with EoE. Clinicians should pay more attention to treatment adherence, particularly in younger patients, and discuss the necessity of treatment.
Collapse
|
7
|
Wickramasekera N, Coates E, Barr A, Lee MJ, Blackwell S, Bedford H, Dames N, Sebastian S, Probert C, Shackley P, Lobo AJ. Patient preferences for treatment in steroid resistant ulcerative colitis - a discrete-choice experiment. Scand J Gastroenterol 2022; 57:797-806. [PMID: 35142585 DOI: 10.1080/00365521.2022.2036808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Understanding treatment preferences in those patients who are not responding to corticosteroids for ulcerative colitis is important in informing treatment choices. This study aimed to assess the relative importance of treatment characteristics to patients by conducting a discrete-choice experiment. METHODS Patients completed the questionnaire online. All data were collected between September and December 2020. Participants were shown 13 discrete-choice experiment tasks - a series of side-by-side comparisons of competing, hypothetical treatment characteristics and asked to select a preferred treatment. Survey responses were analysed using descriptive statistics and regression analyses. RESULTS 115 patients completed the study. Patient preferences were strongest for treatments with a lower chance of side effects, this attribute had the most influence on the choice of treatment patients preferred. The second most important attribute was an improvement in maintaining remission. Conversely, route and frequency of administration were least important on the choice of treatment patients preferred. Respondents were willing to make trade offs and accept treatment benefits to compensate them for receiving a treatment with a less desirable attribute level. Participants were willing to accept a larger benefit of 45% improvement in maintenance of remission to accept a treatment with a higher probability of side effects. The benefit required was smaller with a 10% improvement in remission required to accept a treatment with a lower probability of side effects. CONCLUSION Quantifying preferences helps to identify and prioritise treatment characteristics that are important to patients. The results highlight the importance of careful discussion of side effects, including the magnitude of risk, using visualisation tools during a patient consultation to support decisions.
Collapse
Affiliation(s)
| | - Elizabeth Coates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Amy Barr
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | | | | | - Christopher Probert
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Phil Shackley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan J Lobo
- Inflammatory Bowel Disease Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
8
|
Gohil S, Majd Z, Sheneman JC, Abughosh SM. Interventions to improve medication adherence in inflammatory bowel disease: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:1731-1742. [PMID: 34736829 DOI: 10.1016/j.pec.2021.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To summarize existing literature examining interventions to enhance medication adherence and their effectiveness in enhancing care for inflammatory bowel disease (IBD) patients. METHODS This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. PubMed and Embase were searched for studies from June 2014 to Dec 2020. Only the studies published in English were included. RESULTS Our systematic literature search identified 488 published articles. Seventeen studies with a total of 7073 patients were included. Out of seventeen different interventions, five were classified as educational, eight as multicomponent, three as behavioral and one as cognitive behavioral. Adherence was measured using patient self-report, administrative/pharmacy claims data, and electronic monitoring devices/pill dispensing systems. Twelve out of seventeen interventions showed a statistically significant improvement in medication adherence including three educational, seven multicomponent, one behavioral and one cognitive behavioral intervention. CONCLUSIONS Multicomponent interventions demonstrated the greatest success in IBD patients in promoting medication adherence. Future research should focus on a multidisciplinary approach to design multicomponent interventions to optimize treatment adherence and enhance long-term clinical outcomes. PRACTICE IMPLICATIONS While stand-alone strategies have demonstrated effectiveness in improving adherence, better outcomes may be achieved by combining multiple strategies.
Collapse
Affiliation(s)
- Shrey Gohil
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, TX, USA
| | - Zahra Majd
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, TX, USA
| | | | - Susan M Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, TX, USA
| |
Collapse
|
9
|
Forouzan Z, Gholamrezaie A, Nasimi H, Faramarzi M, Bagheri-Ghalehsalimi A, Nourian SM, Fereidan-Esfahani M, Emami M. Factors associated with adherence to treatment in Iranian patients with inflammatory bowel disease. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:92. [PMID: 34899930 PMCID: PMC8607172 DOI: 10.4103/jrms.jrms_866_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 12/18/2016] [Accepted: 04/16/2017] [Indexed: 06/14/2023]
Abstract
BACKGROUND In this study, we investigated several socioeconomic, clinical, and psychological factors associated with medication adherence in a sample of Iranian patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS This study was conducted on 110 IBD patients from 2013 to 2014 in Isfahan, Iran. The patients were invited to complete three anonymous questionnaires including the Hospital and Anxiety Depression Scale (HADS) for assessing the levels of anxiety and depression; IBD Questionnaire-Short Form (IBDQ-9) for the quality of life; and a visual analog scale assessing the medication adherence. A self-assessment adherence rate of more than 80% was considered "appropriate adherence." RESULTS Overall, 99 patients completed the questionnaires. Among them, 77.8% reportedly adhered to their medications. There was no statistical difference between adherence and nonadherence rates in terms of gender, educational status, disease type, disease severity, and family history of IBD. Conversely, single patients (100% vs. 74.1%; P = 0.03), nonsmokers (79.4% vs. 0.0%; P = 0.04), patients receiving immunosuppressive drugs (100% vs. 71.9%; P = 0.01), and corticosteroids (95.1% vs. 65.5%; P = 0.01) were more likely to be adhered than their counterparts. No differences emerged in terms of the mean HADS scores in either of the sexes. The mean IBDQ-9 score was significantly higher in adhered patients only in females (31.08 ± 11.6 vs. 24.7 ± 9.1; P = 0.04) but not in males. CONCLUSION The adherence rate in our study is almost similar to developed countries. Single marital status, not smoking, receiving corticosteroids and immunosuppressive drugs, and higher IBDQ-9 score in females are associated with higher adherence rate.
Collapse
Affiliation(s)
- Zohre Forouzan
- Department of Gastroenterology, Alzahra hospital, Isfahan University of Medical Sciences and Pour-Sina-Hakim Research Center, Isfahan
| | - Ali Gholamrezaie
- Department of Gastroenterology, Alzahra hospital, Isfahan University of Medical Sciences and Pour-Sina-Hakim Research Center, Isfahan
| | - Hasan Nasimi
- Department of Gastroenterology, Alzahra hospital, Isfahan University of Medical Sciences and Pour-Sina-Hakim Research Center, Isfahan
| | - Mohammad Faramarzi
- Student Research Committee, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran
| | - Amin Bagheri-Ghalehsalimi
- Department of Gastroenterology, Alzahra hospital, Isfahan University of Medical Sciences and Pour-Sina-Hakim Research Center, Isfahan
| | | | - Mahboobeh Fereidan-Esfahani
- Department of Gastroenterology, Alzahra hospital, Isfahan University of Medical Sciences and Pour-Sina-Hakim Research Center, Isfahan
| | - Mohammadhasan Emami
- Department of Gastroenterology, Alzahra hospital, Isfahan University of Medical Sciences and Pour-Sina-Hakim Research Center, Isfahan
| |
Collapse
|
10
|
Aluzaite K, Braund R, Seeley L, Amiesimaka OI, Schultz M. Adherence to Inflammatory Bowel Disease Medications in Southern New Zealand. CROHN'S & COLITIS 360 2021; 3:otab056. [PMID: 36776660 PMCID: PMC9802163 DOI: 10.1093/crocol/otab056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 11/12/2022] Open
Abstract
Background Inflammatory bowel diseases (IBDs) require continuous clinical management; poor medication adherence may result in worse disease outcomes and increased healthcare costs. This study investigated medication adherence and associated risk factors in IBD patients. Methods Otago (New Zealand) IBD patients were mailed questionnaires on demographics, medication-taking behavior, and a validated Probabilistic Medication Adherence Scale (ProMAS). Results The response rate was 29.7% (n = 174/590). The study sample was mean (SD) 50.5 (16.9) years old, 57.9% female, 49.4% had Crohn's disease, and 43.9% ulcerative colitis, with median of 9.5 years (interquartile range: 5.0-22.0) of IBD duration. About 31.1% scored below medium adherence according to ProMAS. About 11.9%, 24.7%, and 23.1% reported failing to renew, purposely not taking, and stopping taking medications, respectively; 27.2% of those who reported having no issues taking medication scored below medium on the ProMAS. Older age was associated with higher ProMAS adherence score (Pearson's r = .25; P = .0014). There were no differences in medication adherence between the types of IBDs (P = .87), disease activity status (P = .70), or gender (P = .27). There was no correlation between the number of medications and level of adherence (Pearson's r = .09; P = .27). About 18.7%, 10.1%, and 5.0% of patients reported forgetting to take medications when traveling, when out of routine, and when busy, respectively. The most used strategies to remember medications included utilizing specific routines (40.1%) and keeping medications in specific locations (21.1%). Conclusions A third of IBD patients had below medium medication adherence. There were discrepancies between self-reported and tool-assessed medication adherence scores with over one-third of patients underestimating/overestimating their adherence.
Collapse
Affiliation(s)
- Kristina Aluzaite
- Gastroenterology Research Unit, Department of Medicine, DSM, University of Otago, Dunedin, New Zealand
| | - Rhiannon Braund
- Department of Preventive and Social Medicine, New Zealand Pharmacovigilance Centre, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Liam Seeley
- Gastroenterology Research Unit, Department of Medicine, DSM, University of Otago, Dunedin, New Zealand
| | | | - Michael Schultz
- Gastroenterology Research Unit, Department of Medicine, DSM, University of Otago, Dunedin, New Zealand,Gastroenterology Unit, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand,Address correspondence to: Michael Schultz, MD, PhD, FRACP, Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand ()
| |
Collapse
|
11
|
Abstract
Inflammatory bowel disease (IBD) is frequently associated with a variety of problematic symptoms, including abdominal pain and bowel habit changes, which are associated with poor patient quality of life and significant healthcare expenditure. Interestingly, silent IBD, a condition where patients demonstrate reduced perception and/or reporting of symptoms in the setting of active inflammation, may be as clinically consequential. This condition has been associated with serious complications leading to more costly interventions. It is by its nature an under-recognized phenomenon that affects substantial portions of patients with either Crohn's disease or ulcerative colitis. At the present time, although there are a variety of theories relating to the underlying causes and contributors, little is known about why this phenomenon occurs. As a result, there is a lack of cost-effective, reliable diagnostic methods to identify and manage "at-risk" patients. However, it is significantly likely that further study and an improved understanding of this condition will lead to improved approaches for the diagnosis and treatment of patients with silent IBD as well as other gastrointestinal disorders associated with alterations in symptomatic perception. In this article, we critically review studies that have investigated silent IBD. Specifically, we discuss the following: (1) the methods for defining silent IBD, (2) the known epidemiology of silent IBD, (3) potential causes of and contributors to this clinical entity, (4) current diagnostic modalities available to identify it, and (5) gaps in our understanding as well as potential novel diagnostic and therapeutic applications that could be developed with further study of this condition.
Collapse
Affiliation(s)
- Matthew D Coates
- Department of Medicine, Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - David G Binion
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
12
|
Chen LM, Bao CH, Wu Y, Liang SH, Wang D, Wu LY, Huang Y, Liu HR, Wu HG. Tryptophan-kynurenine metabolism: a link between the gut and brain for depression in inflammatory bowel disease. J Neuroinflammation 2021; 18:135. [PMID: 34127024 PMCID: PMC8204445 DOI: 10.1186/s12974-021-02175-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/13/2021] [Indexed: 02/08/2023] Open
Abstract
Inflammatory bowel disease (IBD), which mainly includes ulcerative colitis (UC) and Crohn's disease (CD), is a group of chronic bowel diseases that are characterized by abdominal pain, diarrhea, and bloody stools. IBD is strongly associated with depression, and its patients have a higher incidence of depression than the general population. Depression also adversely affects the quality of life and disease prognosis of patients with IBD. The tryptophan-kynurenine metabolic pathway degrades more than 90% of tryptophan (TRP) throughout the body, with indoleamine 2,3-dioxygenase (IDO), the key metabolic enzyme, being activated in the inflammatory environment. A series of metabolites of the pathway are neurologically active, among which kynerunic acid (KYNA) and quinolinic acid (QUIN) are molecules of great interest in recent studies on the mechanisms of inflammation-induced depression. In this review, the relationship between depression in IBD and the tryptophan-kynurenine metabolic pathway is overviewed in the light of recent publications.
Collapse
Affiliation(s)
- Li-Ming Chen
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China
| | - Chun-Hui Bao
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China.
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China.
| | - Yu Wu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China
| | - Shi-Hua Liang
- Faculty of Economics and Business, University of Groningen, Nettelbosje 2, Groningen, 9747 AE, The Netherlands
| | - Di Wang
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China
| | - Lu-Yi Wu
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China
| | - Yan Huang
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China
| | - Hui-Rong Liu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China
| | - Huan-Gan Wu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China.
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China.
| |
Collapse
|
13
|
Davis SP, Ross MSH, Adatorwovor R, Wei H. Telehealth and mobile health interventions in adults with inflammatory bowel disease: A mixed‐methods systematic review. Res Nurs Health 2020; 44:155-172. [DOI: 10.1002/nur.22091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/31/2020] [Accepted: 11/28/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Suja P. Davis
- School of Nursing University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | | | - Reuben Adatorwovor
- Department of Biostatistics University of Kentucky Lexington Kentucky USA
| | - Holly Wei
- College of Nursing East Carolina University Greenville North Carolina USA
| |
Collapse
|
14
|
Chapman S, Sibelli A, St-Clair Jones A, Forbes A, Chater A, Horne R. Personalised Adherence Support for Maintenance Treatment of Inflammatory Bowel Disease: A Tailored Digital Intervention to Change Adherence-related Beliefs and Barriers. J Crohns Colitis 2020; 14:1394-1404. [PMID: 32379303 DOI: 10.1093/ecco-jcc/jjz034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm, tailoring support to address perceptual and practical barriers to adherence, reduced barriers and was acceptable to patients with inflammatory bowel disease [IBD]. METHODS Participants with IBD, prescribed azathioprine and/or mesalazine, were recruited via patient groups, social media, and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and to provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline and at 1 and 3 months of follow-up. RESULTS A total of 329 participants were allocated to the Intervention [n = 153] and Control [n = 176] Groups; just under half [46.2%] completed follow-up. At 1 and 3 months, the Intervention Group had significantly fewer concerns about IBD medication [p ≤0.01]; and at three months, fewer doubts about treatment necessity, fewer reported practical barriers, and higher reported adherence [p <0.05]. Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews, and intervention usage indicated that the intervention was acceptable. CONCLUSIONS Personalised adherence support using a digital algorithm can help patients overcome perceptual barriers [doubts about treatment necessity and medication concerns] and practical barriers to adherence.
Collapse
Affiliation(s)
- Sarah Chapman
- UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK.,Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Alice Sibelli
- UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anja St-Clair Jones
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Pharmacy Department, Brighton, UK
| | - Alastair Forbes
- Institute for Digestive Diseases, University College London, London, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Angel Chater
- UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK.,Centre for Health, Wellbeing and Behaviour Change, Faculty of Education and Sport, University of Bedfordshire, Bedford, UK
| | - Rob Horne
- UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK
| |
Collapse
|
15
|
|
16
|
Rajagopalan A, Sathananthan D, An YK, Van De Ven L, Martin S, Fon J, Costello SP, Begun J, Bryant RV. Gastrointestinal ultrasound in inflammatory bowel disease care: Patient perceptions and impact on disease-related knowledge. JGH OPEN 2019; 4:267-272. [PMID: 32280776 PMCID: PMC7144798 DOI: 10.1002/jgh3.12268] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/30/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
Background and Aim Objective monitoring of disease activity is integral to therapeutic decision-making in inflammatory bowel disease (IBD). Data are sparse on patients' perspectives of tools used to monitor disease activity in IBD. To evaluate patients' perspectives of gastrointestinal ultrasound (GIUS) performed during routine IBD clinical care, along with its impact on IBD-specific knowledge. Methods Patients with a formal diagnosis of IBD who underwent GIUS at two tertiary IBD services between March 2017 and January 2019 participated in this prospective study. Participants completed a questionnaire measuring the acceptability, tolerability, and usefulness of GIUS using a visual analogue scale (VAS) from 0 (disagree) to 10 (strongly agree). Comparative acceptability of IBD monitoring tools and the impact of GIUS on IBD-specific knowledge was measured. Results A total of 121 participants completed the questionnaire, with a mean age of 42 years (range 17-78), 54 (45%) males, and 79 (65%) Crohn's disease patients. In the overall population, GIUS was scored as highly acceptable for monitoring IBD (mean 9.20 ± 1.37) compared to colonoscopy (7.94 ± 2.30), stool sampling (8.17 ± 1.96), blood sampling (8.87 ± 1.62), and imaging (8.67 ± 1.60); P < 0.01 for each comparison. GIUS caused little patient discomfort (1.88 ± 1.83), and 98 (81%) participants ranked GIUS as their preferred IBD monitoring tool. GIUS also improved patients' overall IBD-specific knowledge (VAS IBD-specific knowledge 7.96 ± 1.92), including their understanding of the need for medical therapy and disease extent. Conclusion GIUS is a highly acceptable and well-tolerated tool for monitoring disease activity in IBD patients. GIUS is preferred by patients and enhances IBD-specific knowledge.
Collapse
Affiliation(s)
- Arvind Rajagopalan
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Dharshan Sathananthan
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia.,School of Medicine, Faculty of Health Science University of Adelaide Adelaide South Australia Australia
| | - Yoon-Kyo An
- Department of Gastroenterology Mater Hospital Brisbane Queensland Australia
| | - Lucinda Van De Ven
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Serena Martin
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia
| | - James Fon
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Samuel P Costello
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia.,School of Medicine, Faculty of Health Science University of Adelaide Adelaide South Australia Australia
| | - Jakob Begun
- Department of Gastroenterology Mater Hospital Brisbane Queensland Australia.,Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Robert V Bryant
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia.,School of Medicine, Faculty of Health Science University of Adelaide Adelaide South Australia Australia
| |
Collapse
|
17
|
Zand A, Nguyen A, Stokes Z, van Deen W, Reynolds C, Dimitrova M, Khandadash A, Dvorsky M, Sauk J, Esrailian E, Hommes D. The Development of a Screening Tool to Identify and Classify Nonadherence in Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2019. [DOI: 10.1093/crocol/otz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Medication nonadherence is a challenge in chronic disease management. Tools that can both determine adherence levels and analyze patient-specific reasons for nonadherence are lacking.
Methods
Our tool was developed using 23 patient-reported items and its predictive performance was compared with the most widely used instrument in the literature.
Results
One hundred thirty-three IBD patients were included, 44 (33%) were nonadherent and 89 (67%) were adherent. Our screening question, with 87% sensitivity and 64% specificity, was followed by a 9-item survey for patients qualified as nonadherent.
Conclusions
Quantifying reasons for nonadherence can lead to more effective and personalized interventions for nonadherent patients.
Collapse
Affiliation(s)
- Aria Zand
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
- Department of Digestive Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Audrey Nguyen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Zack Stokes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Welmoed van Deen
- Cedars-Sinai Center for Outcomes Research and Education, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Courtney Reynolds
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Magdalena Dimitrova
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Ariela Khandadash
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Miriam Dvorsky
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Jenny Sauk
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Eric Esrailian
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Daniel Hommes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, CA
- Department of Digestive Diseases, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
18
|
Young age and tobacco use are predictors of lower medication adherence in inflammatory bowel disease. Eur J Gastroenterol Hepatol 2019; 31:948-953. [PMID: 31107739 DOI: 10.1097/meg.0000000000001436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medication adherence is crucial in the management of patients with inflammatory bowel disease (IBD) because medication nonadherence in these patients is associated with an increased risk of flare-up, relapse, recurrence, loss of response to anti-tumour necrosis factor agents, morbidity and mortality, and poor quality of life. Data on risk factors are very controversial in the literature. AIM To assess the prevalence of medication nonadherence and to identify predictors of low medication adherence in Spanish patients with IBD. PATIENTS AND METHODS We carried out a cross-sectional study that included consecutive outpatients with IBD attending in our adult tertiary clinic in a 3-month period. Morisky 8-Item Medication Adherence Scale questionnaire as well as a survey of sociodemographic data were used. RESULTS A total of 181 patients were evaluated. Almost half of the patients (46.4%) had high medication adherence, 30.9% had medium adherence, and 22.7% had low adherence. In relation to predictive factors of medication adherence, multivariate analysis showed that age was associated with high adherence [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.01-1.06; P=0.002]. However, being a smoker and presence of Crohn's disease were associated with low adherence (OR: 3.47; 95% CI: 1.36-8.90; P<0.01 and OR: 2.54; 95% CI: 1.12-5.79; P<0.05, respectively). CONCLUSION Only half of patients were high medication adherers. Young age, active smoking, and Crohn's disease seems to be predictors of low medication adherence. On the basis of these data, efforts for reinforce medication adherence should be especially directed to young patients and smokers.
Collapse
|
19
|
Abstract
OBJECTIVES Mental health disorders comorbid to chronic illness are associated with higher medical care utilization and costs for adults and children. Celiac disease (CD) has a substantial perceived treatment burden and is associated with higher rates of psychopathology in adults. However, establishing the risk for psychological comorbidities in children with CD is still needed. This study aimed to review existing research on mental health concerns in pediatric CD and propose an initial psychosocial research and clinical agenda. METHODS Databases, including Scopus and PubMed. Additional publications were accessed and reviewed from the references provided by initially identified publications. Two investigators screened studies using predetermined criteria (peer-reviewed, published in English, electronically available, inclusive of child participants, and examining CD). One investigator initially extracted data, with subsequent review by the second investigator. RESULTS Twenty-six publications met criteria for the current review (16 case-control, 9 observational, and 1 clinical trial). Publications were heterogeneous in symptoms examined, methodology, and population characteristics. Several studies found elevated risk for psychological comorbidities and poorer quality of life in children with CD. However, many studies were limited by small sample sizes and inconsistent or nonvalidated approaches to measuring psychological symptoms. CONCLUSIONS Many existing studies have found increased prevalence of comorbid CD and psychological symptoms or diagnoses. Therefore, screening for psychological symptoms in CD and also screening for CD in psychological clinic populations is needed. We have identified the importance for further study of mechanisms and risk, and identify preliminary priorities for psychosocial research and clinical care in pediatric CD.
Collapse
|
20
|
Selinger CP, Ochieng AO, George V, Leong RW. The Accuracy of Adherence Self-report Scales in Patients on Thiopurines for Inflammatory Bowel Disease: A Comparison With Drug Metabolite Levels and Medication Possession Ratios. Inflamm Bowel Dis 2019; 25:919-924. [PMID: 30265299 DOI: 10.1093/ibd/izy309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adherence to maintenance medication for inflammatory bowel disease (IBD) is essential for disease control, albeit often poor. Adherence can be measured by drug metabolites, self-report tools, and prescription data. The aim of this study was to test implementation of self-report tools in IBD clinics by evaluating consistency and to validate them by correlation with drug metabolite levels and medication possession ratios (MPRs). METHODS Ambulatory IBD patients on thiopurine maintenance therapy for >3 months were recruited. Patients self-reported adherence using a visual analog scale (VAS) and Medication Adherence Report Scale (MARS). Thiopurine metabolites levels were assessed using blood, and MPRs were calculated from patient records as the reference standard. Consistency was assessed by McNemar's test (primary outcome), and correlation analysis was performed using Pearson tests. RESULTS Of 96 patients (58 Crohn's disease, 33 ulcerative colitis, 5 IBD unclassified) 16.6% were classified as nonadherent based on thiopurine metabolites, 14.9% based on VAS, 13.2% based on MARS, and 22.9% based on MPR. VAS and MARS were consistent with thiopurine metabolites (McNemar test P = 0.79, P = 0.45). All 4 methods were consistent with each other when compared directly 1 to 1. Spearman's analysis demonstrated that all 4 methods significantly correlated with each other: (correlation between VAS and thiopurine metabolites: rho = 0.435; P < 0.001; and correlation between MARS and thiopurine metabolites: rho = 0.29; P = 0.005). CONCLUSIONS Self-report tools correlate significantly with thiopurine metabolites and medication possession ratios. The Medication Adherence Report Scale and VAS are validated adherence assessment tools for IBD and can be used as simple screening tools in clinical practice.
Collapse
Affiliation(s)
- Christian P Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Alvin Odouri Ochieng
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Varun George
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rupert W Leong
- Concord Repatriation General Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| |
Collapse
|
21
|
Perry J, Chen A, Kariyawasam V, Collins G, Choong C, Teh WL, Mitrev N, Kohler F, Leong RWL. Medication non-adherence in inflammatory bowel diseases is associated with disability. Intest Res 2018; 16:571-578. [PMID: 30301333 PMCID: PMC6223449 DOI: 10.5217/ir.2018.00033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Medication non-adherence is common in inflammatory bowel diseases (IBD). The short-term consequences of non-adherence include increased disease relapse but the long-term impact upon patients in terms of daily functional impairment are less well characterized. Identifying negative outcomes, such as disability, may encourage adherence. Methods Consecutive ambulatory IBD subjects completed the Medication Adherence Rating Scale (MARS; non-adherence defined as ≤16), Inflammatory Bowel Diseases Disability Index (IBD-DI; disability: <3.5) and Beliefs about Medicines Questionnaire (high necessity/concerns: ≥16). The primary outcome was the association between medication non-adherence and disability. Secondary outcomes were the predictors of these outcomes. Results A total of 173 subjects on IBD maintenance medications were recruited (98 Crohn's disease, 75 ulcerative colitis: median IBD-DI, -5.0; interquartile range [IQR], -14.0 to 4.0 and median MARS, 19.0; IQR, 18 to 20) of whom 24% were non-adherent. Disability correlated significantly with medication non-adherence (r=0.38, P<0.0001). Median IBD-DI for non-adherers was significantly lower than adherers (-16.0 vs. -2.0, P<0.0001). Predictors of disability included female sex (P=0.002), previous hospitalization (P=0.023), management in a referral hospital clinic (P=0.008) and medication concerns (P<0.0001). Non-adherence was independently associated with difficulty managing bowel movements (odds ratio [OR], 3.71; 95% confidence interval [CI], 1.50-9.16, P=0.005), rectal bleeding (OR, 2.69; 95% CI, 1.14-6.36; P=0.024) and arthralgia/arthritis (OR, 2.56; 95% CI, 1.11-5.92; P=0.028). Conclusions Medication non-adherence was associated with significantly increased disability in IBD. Female gender, higher disease severity and medication concerns were additional predictors of disability.
Collapse
Affiliation(s)
| | - Andy Chen
- Faculty of Medicine, University of New South Wales, Australia
| | - Viraj Kariyawasam
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Glen Collins
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Chee Choong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Wei Ling Teh
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Nikola Mitrev
- Sydney Medical School, University of Sydney, Australia
| | | | - Rupert Wing Loong Leong
- Sydney Medical School, University of Sydney, Australia.,Faculty of Medicine, University of New South Wales, Australia.,Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| |
Collapse
|
22
|
Dibley L, Czuber-Dochan W, Woodward S, Wade T, Bassett P, Sturt J, Norton C. Development and Psychometric Properties of the Inflammatory Bowel Disease Distress Scale (IBD-DS): A New Tool to Measure Disease-Specific Distress. Inflamm Bowel Dis 2018; 24:2068-2077. [PMID: 29788323 DOI: 10.1093/ibd/izy108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) imposes a heavy psychosocial burden, with many patients reporting anxiety, depression, and distress. In diseases such as diabetes, disease-specific distress is associated with concordance with treatments and disease control. IBD distress, distinct from anxiety and depression, is evident in people with IBD. We aimed to develop a questionnaire for assessing IBD-specific distress, validate this against a gold standard distress measure for diabetes, and demonstrate the difference between anxiety, depression, and distress. METHODS The 94-item IBD Distress Scale (IBD-DS) was developed through secondary analysis of 3 qualitative data sets from previous IBD studies. Items were then refined through cognitive interviews in 2 stages (n = 15, n = 3). Three supplementary unscored questions were added to enable patients to identify their overall level of distress, their perceived level of disease activity, and their 3 most distressing issues. Subsequently, the 55-item IBD Distress Scale was subjected to test-retest. Two hundred seventy-five people received the test draft IBD-DS, and 168 responded (60.4%). Of these, 136 (82%) returned the retest draft of IBD-DS 3 weeks later. After analysis, further item reduction was informed by response rates, kappa values, and correlation coefficients, and test-retest was repeated. One hundred fifty-four people received the test final 28-item IBD-DS, and 123 people responded (58.8%). Of these, 95 (77%) returned the retest final IBD-DS. RESULTS The 94 items were reduced to 28 items. Good intraclass correlation (ICC) was found between test-retest scores on 72 complete data sets with unchanged disease status (ICC, 0.92; 95% confidence interval, 0.88-0.95). Cronbach's alpha was 0.95, indicating excellent internal consistency. Factor analysis indicated scoring the items as a single domain (score range, 0-168). CONCLUSION The final IBD-DS performs well and offers a tool for assessing IBD-specific distress.
Collapse
Affiliation(s)
- Lesley Dibley
- Faculty of Education and Health, University of Greenwich, London, United Kingdom.,Bart's Health NHS Trust, London, United Kingdom
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Sue Woodward
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Tiffany Wade
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Paul Bassett
- Independent Statistician, Amersham, United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | | |
Collapse
|
23
|
Eindor-Abarbanel A, Naftali T, Ruhimovich N, Bar-Gil Shitrit A, Sklerovsky-Benjaminov F, Konikoff F, Matalon S, Shirin H, Milgrom Y, Broide E. Revealing the Puzzle of Nonadherence in IBD-Assembling the Pieces. Inflamm Bowel Dis 2018; 24:1352-1360. [PMID: 29718228 DOI: 10.1093/ibd/izy013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adherence is generally associated with improved treatment outcomes in inflammatory bowel disease (IBD) patients. Different components of the patient profile have an impact on patient adherence. Capturing nonadherent patients by identifying modifiable risk factors in daily practice still remains a challenge. The objective of this study was to identify modifiable and nonmodifiable risk factors for nonadherence in IBD patients. METHODS Patients filled out questionnaires including demographic, clinical, and socioeconomic information and accessibility to gastrointestinal services. Psychological features were assessed using the Sense of Coherence, Hospital Anxiety and Depression Scale, IBD-Self Efficacy, and Brief Illness Perception (BIPQ) questionnaires. Adherence to treatment was evaluated using the Morisky score. RESULTS The study included 311 patients: 62.4% females, median age 34.78 years, 70.4% Crohn's disease (CD). Multivariate analysis was done in 3 sections: demographic and disease characteristics, communication with medical staff, and psychological aspects; all included sex and disease type. Ulcerative colitis (UC) patients were less adherent (odds ratio [OR], 1.792; OR, 1.915; OR, 1.748; respectively). Females were less adherent in 2 sections (OR, 1.841; OR, 1.751; respectively). Employment (OR, 2.449), low score in on the BIPQ-understanding of disease (OR, 0.881), and poor communication with the gastroenterologist (OR, 1.798) were also predictors of low adherence. CONCLUSIONS Nonmodifiable characteristics such as female sex and UC are associated with low adherence. Good communication with the treating physician and understanding the disease are modifiable factors associated with high adherence. Early intervention might improve patients' adherence.
Collapse
Affiliation(s)
- Adi Eindor-Abarbanel
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Assaf Harofeh Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Timna Naftali
- Department of Gastroenterology and Hepatology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nahum Ruhimovich
- Department of Gastroenterology and Hepatology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Fabiana Sklerovsky-Benjaminov
- Department of Gastroenterology and Hepatology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fred Konikoff
- Department of Gastroenterology and Hepatology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Matalon
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Assaf Harofeh Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Haim Shirin
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Assaf Harofeh Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yael Milgrom
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Efrat Broide
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Assaf Harofeh Medical Center, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
24
|
Optimizing Selection of Biologics in Inflammatory Bowel Disease: Development of an Online Patient Decision Aid Using Conjoint Analysis. Am J Gastroenterol 2018; 113:58-71. [PMID: 29206816 DOI: 10.1038/ajg.2017.470] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Recent drug approvals have increased the availability of biologic therapies for inflammatory bowel disease (IBD), making it difficult for patients with ulcerative colitis (UC) and Crohn's disease (CD) to navigate treatment options. Here we developed a conjoint analysis to examine patient decision-making surrounding biologic medicines for IBD. We used the results to create an online patient decision aid that generates a unique "preferences report" for each patient to assist with shared decision-making with their provider. METHODS We administered an adaptive choice-based conjoint survey to IBD patients that quantifies the relative importance of biologic attributes (e.g., efficacy, side effect profile, mode of administration, and mechanism of action) in decision making. The conjoint software determined individual patient preferences by calculating part-worth utilities for each attribute. We conducted regression analyses to determine if demographic and disease characteristics (e.g., type of IBD and severity) predicted how patients made decisions. RESULTS 640 patients completed the survey (UC=304; CD=336). In regression analyses, demographics and IBD characteristics did not predict individual patient preferences; the main exception was IBD type. When compared to UC, CD patients were more likely to report side effect profile as most important (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.16-2.30). Conversely, those with UC were more likely to value therapeutic efficacy (OR 1.41, 95% CI 1.01-2.00). CONCLUSIONS Biologic decision-making is highly personalized; demographic and disease characteristics poorly predict individual preferences, indicating that IBD patients are unique and difficult to statistically categorize. The online decision tool resulting from this study (www.ibdandme.org) may be used by patients to support shared decision-making and optimize personalized biologic selection with their provider.
Collapse
|
25
|
Inflammatory Bowel Disease Pharmacist Adherence Counseling Improves Medication Adherence in Crohn's Disease and Ulcerative Colitis. Inflamm Bowel Dis 2017; 23:1257-1261. [PMID: 28719539 DOI: 10.1097/mib.0000000000001194] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND While inflammatory bowel diseases (IBD) require long-term medication usage to maintain remission, nonadherence is common and adversely associated with poorer clinical outcomes. Personalized IBD Pharmacist Adherence Counselling, based on the Health Beliefs Model of medication perception, may increase medication adherence. METHODS This prospective multi-center longitudinal parallel study recruited consecutive IBD subjects that were classified as baseline medication non-adherers and adherers. Non-adherers received a single IBD Pharmacist Adherence Counselling intervention at baseline, while adherers served as controls. Medication Adherence Report Scale and Beliefs about Medicines Questionnaire were administered up to 24 months. Medication acceptance was defined as high perception of medication necessity with low concerns. The primary endpoint was medication adherence at 24 months. RESULTS Of 114 subjects approached, 100 completed follow-up, with 36 being baseline nonadherers (median Medication Adherence Report Scale = 15.0) and 64 baseline adherers (median Medication Adherence Report Scale = 19.0; P < 0.001). At 24 months, nonadherence in the IBD Pharmacist Adherence Counselling group decreased from 100% to 44.4% (P = 0.001), whereas nonadherence in controls remained unchanged (P = 0.38). Individually, Beliefs about Medicines Questionnaire Necessity and Concern scores showed no significant changes in both groups, but medication acceptance significantly improved in baseline nonadherers at 12 months (P = 0.031) with a trend toward durable improvement at 24 months (P = 0.063). CONCLUSIONS Medication nonadherence in IBD can be improved through a single personalized counseling session by an IBD pharmacist, and the benefit was durable for 2 years. This benefit was through improving the acceptance of medication.
Collapse
|
26
|
Pediatric-to-adult Transition and Medication Adherence in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 2017; 23:1065-1070. [PMID: 28498154 DOI: 10.1097/mib.0000000000001114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medication nonadherence is common in inflammatory bowel disease and is associated with poor outcomes. There has been no study on pediatric-to-adult transition as a risk factor for nonadherence in inflammatory bowel disease, which has been demonstrated in other diseases. We aimed to assess whether transitioned (TR) patients have higher nonadherence rates than young adults (YAs) diagnosed in adulthood. METHODS Consecutive ambulatory subjects were prospectively recruited and completed the validated Medication Adherence Reporting Scale (MARS), with the primary outcome being adherence differences between group age-matched TR and YA groups. Pediatric subjects were taken as the control group. Perceptions of medication-related necessity and concerns were assessed with the Beliefs about Medicines Questionnaire (BMQ). Nonadherers (defined as MARS ≤16) received the Inflammatory Bowel Diseases Pharmacist Adherence Counselling (IPAC) intervention and adherence change was reassessed after 6 months as a secondary outcome. RESULTS Adherence in TR patients (n = 38, mean age 20.4, 13.2% nonadherent) was noninferior to and numerically better than YAs diagnosed in adulthood (n = 41, mean age 21.2, 24.4%). Nonadherence in the pediatric control group (n = 50, mean age 14.7) was 8.0%. YAs had significantly higher medication-related concerns (14.6 versus 11.9, P = 0.02) than the pediatric group. The IPAC intervention reduced nonadherence rates by 60% (P = 0.004). CONCLUSIONS TR patients did not have worse adherence than YAs diagnosed in adulthood. Protective factors may include previous treatment in pediatric centers and the salient symptomatology of inflammatory bowel disease, whereas increasing concerns over medications contribute to nonadherence in YAs. Pharmacist-led counselling improves adherence in these patients.
Collapse
|
27
|
Lenti MV, Selinger CP. Medication non-adherence in adult patients affected by inflammatory bowel disease: a critical review and update of the determining factors, consequences and possible interventions. Expert Rev Gastroenterol Hepatol 2017; 11:215-226. [PMID: 28099821 DOI: 10.1080/17474124.2017.1284587] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Achieving adherence to medications can be a serious challenge for patients affected by inflammatory bowel disease (IBD). Medical treatment is fundamental for inducing and maintaining remission, preventing flares and reducing the risk of colorectal cancer. Non-adherence may affect patients' quality of life resulting in unfavourable treatment outcomes, more hospitalizations and higher healthcare-related costs. Recognising and improving adherence is therefore a primary aim for the treatment of IBD. Areas covered: We critically discuss the current knowledge on medication non-adherence in adult patients affected by IBD, also mentioning a few issues concerning the paediatric and adolescent populations. In particular, we reviewed the literature focusing on the definition and detection of non-adherence, on its extent and on the possible non-modifiable and modifiable factors involved (patient-centred, therapy-related, disease-related and physician-related). Furthermore, we analysed the interventional studies performed so far. The literature review was conducted through PubMed addressing medication non-adherence in IBD, using the keywords 'adherence' and related terms and 'IBD, ulcerative colitis or Crohn's disease'. Expert commentary: Adherence to therapy for IBD is a complex yet fundamental issue that cannot be solved by addressing a single aspect only. Future studies should focus on patient-tailored and multidimensional interventions.
Collapse
Affiliation(s)
- Marco Vincenzo Lenti
- a First Department of Internal Medicine , San Matteo Hospital Foundation; University of Pavia , Pavia , Italy.,b Department of Gastroenterology , Leeds Teaching Hospitals NHS Trust, University of Leeds , Leeds , UK
| | - Christian P Selinger
- b Department of Gastroenterology , Leeds Teaching Hospitals NHS Trust, University of Leeds , Leeds , UK
| |
Collapse
|
28
|
Soobraty A, Boughdady S, Selinger CP. Current practice and clinicians’ perception of medication non-adherence in patients with inflammatory bowel disease: A survey of 98 clinicians. World J Gastrointest Pharmacol Ther 2017; 8:67-73. [PMID: 28217376 PMCID: PMC5292608 DOI: 10.4292/wjgpt.v8.i1.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/24/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023] Open
Abstract
AIM The survey ascertains perceptions and describes current practice of clinicians regarding medication non-adherence in patients with Inflammatory Bowel Disease.
METHODS Gastroenterologists, trainees and inflammatory bowel disease (IBD) specialist nurses from the United Kingdom were invited to a web based survey collecting data on clinician demographics, patient volume and level of interest in IBD. Respondents were asked to estimate non-adherence levels and report use of screening tools and interventions to improve adherence.
RESULTS Non-adherence was seen as an infrequent problem by 57% of 98 respondents. Levels of non-adherence were estimated lower than evidence suggests by 29% for mesalazine (5ASA), 26% for immunomodulators (IMM) and 21% for biologics (BIOL). Respondents reporting non-adherence as a frequent problem were more likely to report adherence levels in line with evidence (5ASA P < 0.001; IMM P = 0.012; BIOL P = 0.015). While 80% regarded screening as important only 25% screen regularly (40% of these with validated assessment tools). Respondents stated forgetfulness, beliefs about necessity of medication and not immediately apparent benefits as the main reasons for non-adherence. Patient counselling on benefits and risks of medication was a commonly used intervention.
CONCLUSION Clinicians treating IBD patients frequently underestimate non-adherence and use of validated screening tools is infrequent. Most respondents identified the main factors associated with non-adherence in line with evidence and often counselled patients accordingly. Professional education should focus more on non-adherence practice to avoid adverse treatment outcomes associated with non-adherence.
Collapse
|
29
|
Pinder M, Lummis K, Selinger CP. Managing inflammatory bowel disease in pregnancy: current perspectives. Clin Exp Gastroenterol 2016; 9:325-335. [PMID: 27789969 PMCID: PMC5072556 DOI: 10.2147/ceg.s96676] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Inflammatory bowel disease (IBD) affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss. As such, women with IBD face complex decision making weighing the risks of active disease versus those of medical treatments. This review summarizes the current evidence regarding the safety and efficacy of IBD treatments during pregnancy and lactation aiming to provide up-to-date guidance for clinicians. Over 50% of women have poor IBD- and pregnancy-related knowledge, which is associated with views contrary to medical evidence and voluntary childlessness. This review highlights the effects of poor patient knowledge and critically evaluates interventions for improving patient knowledge and outcomes.
Collapse
Affiliation(s)
- Matthew Pinder
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust
| | - Katie Lummis
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust
| | - Christian P Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust
- University of Leeds, Leeds, UK
| |
Collapse
|
30
|
van den Heuvel TRA, Wintjens DSJ, Jeuring SFG, Wassink MHH, Romberg-Camps MJL, Oostenbrug LE, Sanduleanu S, Hameeteman WH, Zeegers MP, Masclee AA, Jonkers DM, Pierik MJ. Inflammatory bowel disease, cancer and medication: Cancer risk in the Dutch population-based IBDSL cohort. Int J Cancer 2016; 139:1270-80. [PMID: 27170593 DOI: 10.1002/ijc.30183] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 02/06/2023]
Abstract
The management of inflammatory bowel disease (IBD) has changed since the mid-1990s (e.g., use of thiopurines/anti-TNFα agents, improved surveillance programs), possibly affecting cancer risk. To establish current cancer risk in IBD, updates are warranted from cohorts covering this time span, and detailed enough to study associations with phenotype and medication. We studied intestinal-, extra-intestinal- and overall cancer risk in the Dutch population-based IBDSL cohort. In total, 1,157 Crohn's disease (CD) and 1,644 ulcerative colitis (UC) patients were diagnosed between 1991 and 2011, and followed until 2013. Standardized incidence ratios (SIRs) were calculated for CD and UC separately, as well as for gender-, phenotype-, disease duration-, diagnosis era- and medication groups. We found an increased risk for colorectal cancer in CD patients with colon involvement (SIR 2.97; 95% CI 1.08-6.46), but not in the total CD or UC population. In addition, CD patients were at increased risk for hematologic- (2.41; 1.04-4.76), overall skin- (1.55; 1.06-2.19), skin squamous cell- (SCC; 3.83; 1.83-7.04) and overall cancer (1.28; 1.01-1.60), whereas UC patients had no increased risk for extra-intestinal- and overall cancer. Finally, in a medication analysis on CD and UC together, long-term immunosuppression exposure (>12 months) was associated with an increased risk for hematologic cancer, non-Hodgkin lymphoma, SCC and overall cancer, and this increase was mainly attributed to thiopurines. IBD patients with long-term immunosuppression exposure can be considered as having a higher cancer risk, and our data support the advice in recent IBD guidelines to consider skin cancer screening in these patients.
Collapse
Affiliation(s)
- Tim R A van den Heuvel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dion S J Wintjens
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Steven F G Jeuring
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maartje H H Wassink
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marielle J L Romberg-Camps
- Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Liekele E Oostenbrug
- Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Silvia Sanduleanu
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wim H Hameeteman
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maurice P Zeegers
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Complex Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ad A Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daisy M Jonkers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marie J Pierik
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
31
|
Abstract
BACKGROUND AND AIM Inflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring medical therapy to maintain clinical remission. Low adherence to therapy leads to poorer disease outcome. Therefore, we aimed to identify predictors of low adherence in the Belgian IBD population. PATIENTS AND METHODS Between November 2013 and March 2014, 570 ambulatory patients (471 patients with IBD and 99 non-IBD controls) visiting a tertiary IBD-referral centre were requested to complete the Morisky 8-Item Medication Adherence Scale (MMAS-8) questionnaire as well as a survey of sociodemographic data (smoking, educational level, marital status and occupation). On the basis of the self-reported MMAS questionnaire, adherence was categorized as low (MMAS-8 score: >2), medium (MMAS-8 score: 1-2) or high (MMAS-8 score: 0). RESULTS The response rate in the IBD population was as high as 99%. Low adherence was reported less frequently in the IBD population than in the non-IBD controls (36 vs. 49%, P=0.021). In multivariate analysis, factors associated independently with low adherence in the IBD population were age younger than 40 [odds ratio: 1.589 (95% confidence interval: 1.057-2.389), P=0.026], higher educational level [1.961 (1.305-2.946), P=0.001], being single [1.641 (1.020-2.639), P=0.041] and the use of mesalamine [1.591 (1.018-2.487), P=0.041]. Self-employment was identified as a protective factor for low adherence [0.397 (0.167-0.946), P=0.041]. CONCLUSION Approximately one-third of the IBD patients were low adherers. Predictors of low adherence were aged younger than 40 years, higher educational level, being single and mesalamine use, whereas being self-employed was a protective factor. On the basis of these data, personalized algorithms may be developed to improve patient education, empowerment and follow-up.
Collapse
|
32
|
Armuzzi A, Gionchetti P, Daperno M, Danese S, Orlando A, Lia Scribano M, Vecchi M, Rizzello F. Expert consensus paper on the use of Vedolizumab for the management of patients with moderate-to-severe Inflammatory Bowel Disease. Dig Liver Dis 2016; 48:360-70. [PMID: 26821929 DOI: 10.1016/j.dld.2015.12.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 02/07/2023]
Abstract
Crohn's Disease (CD) and Ulcerative Colitis (UC) are chronic, relapsing conditions resulting from uncontrolled inflammation of the intestinal mucosa. Both conditions are associated with significant disability and patients with CD face higher mortality rates compared to the general population. The increasing understanding of the immunological basis of the disease led to the introduction of biologic therapies targeting key pathways of the natural and adaptive immune response such as Tumor Necrosis Factor α (TNF-α) inhibitors and, more recently, integrin-receptor antagonists. Treatment with TNF-α inhibitors improved clinical and patient-reported outcomes for many patients who did not benefit from conventional therapy. However, a sizeable share of patients still face suboptimal outcomes due to primary or secondary therapy failure. With the introduction of VDZ, a biologic treatment targeting novel IBD-relevant biologic pathways, it is crucial to understand how to integrate such innovations into current clinical practice. To this end, a panel of 14 Italian experts in the management of IBD met for a roundtable discussion. Recommendations concerning the management of moderate-to-severe IBD based on experts' opinions and literature review are discussed in the present report.
Collapse
Affiliation(s)
- Alessandro Armuzzi
- IBD Unit, Complesso Integrato Columbus, Fondazione Policlinico Gemelli, Università Cattolica, Rome, Italy
| | | | - Marco Daperno
- SC Gastroenterologia, AO Ordine Mauriziano, Turin, Italy
| | - Silvio Danese
- IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ambrogio Orlando
- Biomedical Department of Internal and Specialist Medicine (DIBIMIS), Division of Medicine, Villa Sofia-V. Cervello Hospital, Palermo University, Palermo, Italy
| | - Maria Lia Scribano
- Unit of Gastroenterology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Maurizio Vecchi
- Dipartimento di Scienze Biomediche per la Salute, Università di Milano, Milan, Italy
| | | | | |
Collapse
|
33
|
Importance of Patients' Knowledge of Their Prescribed Medication in Improving Treatment Adherence in Inflammatory Bowel Disease. J Clin Gastroenterol 2016; 50:157-62. [PMID: 26501880 DOI: 10.1097/mcg.0000000000000431] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOALS To investigate the association between treatment nonadherence and patients' knowledge of the prescribed medication among individuals with inflammatory bowel disease (IBD), and evaluate the impact of nonadherence on relapse. BACKGROUND The patient's knowledge of the prescribed medication has been identified as an important predictor of treatment adherence in chronic diseases. However, this association has not been examined in IBD. STUDY In this prospective study, at baseline, 138 patients with IBD completed a self-reported survey on demographic data, knowledge of the prescribed medication, and candidate factors related to the degree of treatment adherence. To investigate the impact of nonadherence among patients in remission, relapse was analyzed for 18 months after enrollment. RESULTS Nonadherence was observed in 50 (36.2%) of the 138 subjects. In multivariate analysis, nonadherence was significantly associated with younger age (less than 30 y) at participation [odds ratio (OR), 5.88; 95% confidence interval (CI), 1.51-22.94; P=0.011], longer intervals between outpatient clinic visits (≥3 mo) (OR, 30.31; 95% CI, 3.06-300.17; P=0.004), and limited knowledge of the prescribed medication (OR, 5.61; 95% CI, 1.60-19.67; P=0.038). Nonadherent patients had a significantly greater risk of relapse of IBD than adherent patients (relative risk, 2.9; 95% CI, 2.25-3.79; P=0.045). CONCLUSION Younger age, longer intervals between outpatient clinic visits, and limited knowledge of the prescribed medication tended to be associated with nonadherence to treatment, which consequently also affects the risk of relapse.
Collapse
|
34
|
Ooi CJ, Makharia GK, Hilmi I, Gibson PR, Fock KM, Ahuja V, Ling KL, Lim WC, Thia KT, Wei SC, Leung WK, Koh PK, Gearry RB, Goh KL, Ouyang Q, Sollano J, Manatsathit S, de Silva HJ, Rerknimitr R, Pisespongsa P, Abu Hassan MR, Sung J, Hibi T, Boey CCM, Moran N, Leong RWL. Asia-Pacific consensus statements on Crohn's disease. Part 2: Management. J Gastroenterol Hepatol 2016; 31:56-68. [PMID: 25819311 DOI: 10.1111/jgh.12958] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 02/05/2023]
Abstract
The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field.
Collapse
Affiliation(s)
- Choon Jin Ooi
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Ida Hilmi
- Division of Gastroenterology and Hepatology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Peter R Gibson
- Monash University Department of Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Kwong Ming Fock
- Department of Gastroenterology, Changi General Hospital, Singapore
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Khoon Lin Ling
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Wee Chian Lim
- Department of Gastroenterology, Tan Tock Seng Hospital, Singapore
| | - Kelvin T Thia
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Shu-chen Wei
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Poh Koon Koh
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Khean Lee Goh
- Division of Gastroenterology and Hepatology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Qin Ouyang
- Division of Gastroenterology, Department of Internal Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jose Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Sathaporn Manatsathit
- Department of Medicine, Division of Gastroenterology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - H Janaka de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Pises Pisespongsa
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Joseph Sung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | | | | | - Neil Moran
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
| | - Rupert W L Leong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
| | | |
Collapse
|
35
|
Freitas TH, Hyphantis TN, Andreoulakis E, Quevedo J, Miranda HL, Alves GS, Souza MH, Braga LL, Pargament KI, Soczynska JK, McIntyre RS, Carvalho AF. Religious coping and its influence on psychological distress, medication adherence, and quality of life in inflammatory bowel disease. BRAZILIAN JOURNAL OF PSYCHIATRY 2015; 37:219-27. [DOI: 10.1590/1516-4446-2014-1507] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - João Quevedo
- The University of Texas Medical School at Houston, USA; Universidade do Extremo Sul Catarinense, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Hou JK, Turkeltaub JA, McCarty III TR, El-Serag HB. Assessment of disease specific knowledge and health-related quality of life among United States military veterans with inflammatory bowel disease. World J Gastroenterol 2015; 21:6001-6007. [PMID: 26019466 PMCID: PMC4438036 DOI: 10.3748/wjg.v21.i19.6001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/09/2015] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the association between patient disease knowledge of inflammatory bowel disease (IBD) and health related quality of life (HRQoL) and identify patient and disease related predictors of patient knowledge of IBD.
METHODS: We performed a cross-sectional study of IBD patients with an established diagnosis of IBD longer than 3 mo prior to enrollment. The Crohn’s and colitis knowledge score (CCKNOW) and short inflammatory bowel disease questionnaire (SIBDQ) were self-administered to assess patient knowledge of IBD and HRQoL, respectively. Demographic and disease characteristics were abstracted from the electronic medical record. The correlation between CCKNOW and SIBDQ scores was assessed by a linear regression model. Associations of patient knowledge and the variables of interest were calculated using ANOVA.
RESULTS: A total of 101 patients were recruited. Caucasian race, younger age at diagnosis, and having a college or post-graduate degree were significantly associated with higher CCKNOW scores. Patients with CD had higher CCKNOW scores compared to patients with ulcerative colitis and inflammatory bowel disease type unclassified, P < 0.01. There was no significant correlation between overall CCKNOW and SIBDQ scores (r2 = 0.34, P = 0.13). The knowledge sub-domain of diet in CCKNOW was negatively correlated with HRQoL (r2 = 0.69, P < 0.01).
CONCLUSION: IBD diagnosis at a younger age in addition to Caucasian race and higher education were significantly associated with higher knowledge about IBD. However, patient knowledge of IBD was not correlated with HRQoL. Further studies are required to study the effect of patient knowledge of IBD on other clinical outcomes.
Collapse
|
37
|
Affiliation(s)
- Christian P Selinger
- Gastroenterology, Leeds Teaching Hospitals NHS Trust, St James University Hospital , Leeds , UK
| |
Collapse
|
38
|
Feagan BG, Kozma CM, Slaton TL, Olson WH, Wan GJ. Healthcare costs for Crohn's disease patients treated with infliximab: a propensity weighted comparison of the effects of treatment adherence. J Med Econ 2014; 17:872-80. [PMID: 25162777 DOI: 10.3111/13696998.2014.950669] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective for the research was to evaluate the direct healthcare costs for Crohn's disease (CD) patients categorized by adherence status. METHODS Adult patients with ≥1 claim for infliximab and ≥2 claims for CD who were continuously insured for 12 months before and after their first infliximab infusion (index date) were identified in a 2006-2009 US managed care database. Patients were excluded if they had rheumatoid arthritis claims, received infliximab billed as a pharmacy benefit, or received another biologic drug. Patients were categorized as being either adherent or intermittently adherent to infliximab using a pre-defined algorithm. Total and component direct costs, CD-related costs, rates of surgery, and days of hospitalization were estimated for the 360-day post-index period. Propensity weighted generalized linear models were used to adjust the cost estimates for potential confounding variables. RESULTS The total propensity weighted cost for infliximab adherent patients was $40,425 (95% CI = [$38,686, $42,242]), compared to $41,082 (95% CI = [$38,163, $44,223]) for the intermittently adherent (p = 0.71). However, adherent patients had lower total direct medical costs, exclusive of infliximab, that were $13,097 (95% CI = [$12,141, $14,127]) compared with $20,068 (95% CI = [$17,676, $22,784]) for intermittently adherent patients as a result of substantially lower hospital and outpatient costs (p < 0.0001). CONCLUSIONS Greater drug-related costs for infliximab adherent patients were offset by lower costs from hospitalization and outpatient visits. These findings indicate that adherent patients have improved clinical outcomes, at a similar aggregate cost, than patients who are only intermittently adherent to therapy.
Collapse
Affiliation(s)
- Brian G Feagan
- Robarts Research Institute, University of Western Ontario , Canada
| | | | | | | | | |
Collapse
|
39
|
Mocciaro F, Di Mitri R, Russo G, Leone S, Quercia V. Motivational interviewing in inflammatory bowel disease patients: a useful tool for outpatient counselling. Dig Liver Dis 2014; 46:893-7. [PMID: 25085685 DOI: 10.1016/j.dld.2014.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/09/2014] [Accepted: 07/08/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most inflammatory bowel disease patients miss follow-up visits and are non-adherent to therapy due to the lack of an engaging patient-physician relationship. Motivational interviewing is a patient-centred counselling method used to elicit/strengthen motivation towards change. The aim of this study was to assess the role of motivational interviewing in patients affected by inflammatory bowel disease. METHODS The study included consecutive patients with inflammatory bowel disease presenting for the first consultation (June 2012-February 2013). All consultations were carried out applying the motivational interviewing approach. After each consultation, patients filled out a questionnaire asking demographic data, and their past and current experience. RESULTS Overall, 23 males (51.1%) and 22 females (48.9%), mean age 36.1±15.2 years, were enrolled. Before and after experiencing the motivational interviewing approach (mean visit duration 41.5±8.7min) "overall satisfaction rate", "physician's communication skills", and "perceived empathy" were 60% vs 100%, 40% vs 95.6%, and 40% vs 100%, respectively. Satisfaction was lower in patients affected by indeterminate colitis (p=0.004), and of younger age (p=0.02). CONCLUSION The motivational interview approach is appreciated by inflammatory bowel disease patients. Despite being time-consuming, the motivational interview appears considerably worthwhile at the first visit and in younger patients. Motivational interviewing can help physicians to deal with their patients, moving from "cure" to "care".
Collapse
Affiliation(s)
- Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy.
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Giuseppina Russo
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | | | - Valerio Quercia
- MINT (Motivational Interviewing Network of Trainers), Rome, Italy
| |
Collapse
|
40
|
Haga SB, Mills R, Bosworth H. Striking a balance in communicating pharmacogenetic test results: promoting comprehension and minimizing adverse psychological and behavioral response. PATIENT EDUCATION AND COUNSELING 2014; 97:10-5. [PMID: 24985359 PMCID: PMC4162835 DOI: 10.1016/j.pec.2014.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/29/2014] [Accepted: 06/15/2014] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Pharmacogenetic (PGx) testing can provide information about a patient's likelihood to respond to a medication or experience an adverse event, and be used to inform medication selection and/or dosing. Promoting patient comprehension of PGx test results will be important to improving engagement and understanding of treatment decisions. METHODS The discussion in this paper is based on our experiences and the literature on communication of genetic test results for disease risk and broad risk communication strategies. RESULTS Clinical laboratory reports often describe PGx test results using standard terminology such as 'poor metabolizer' or 'ultra-rapid metabolizer.' While this type of terminology may promote patient recall with its simple, yet descriptive nature, it may be difficult for some patients to comprehend and/or cause adverse psychological or behavioral responses. CONCLUSION The language used to communicate results and their significance to patients will be important to consider in order to minimize confusion and potential psychological consequences such as increased anxiety that can adversely impact medication-taking behaviors. PRACTICE IMPLICATIONS Due to patients' unfamiliarity with PGx testing and the potential for confusion, adverse psychological effects, and decreased medication adherence, health providers need to be cognizant of the language used in discussing PGx test results with patients.
Collapse
Affiliation(s)
- Susanne B Haga
- Institute for Genome Sciences & Policy and Sanford School of Public Policy, Duke University, Durham, USA.
| | - Rachel Mills
- Institute for Genome Sciences & Policy, Duke University, Durham, USA
| | - Hayden Bosworth
- Departments of Medicine, Psychiatry, and Nursing, Duke University, Center for Health Services Research in Primary Care, Durham VAMC, Durham, USA
| |
Collapse
|
41
|
Selinger CP, Kemp A, Leong RW. Persistence to oral 5-aminosalicylate therapy for inflammatory bowel disease in Australia. Expert Rev Gastroenterol Hepatol 2014; 8:329-34. [PMID: 24490626 DOI: 10.1586/17474124.2014.882768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aminosalicylate (5-ASA) is effective treatment for inflammatory bowel diseases (IBDs) but requires continuous maintenance therapy. This study determines persistence of 5-ASA in IBD using national population-based data for Australia from 2002 to 2011 with follow up for 36 months. Non-persistence was defined as failing to fill a prescription for 3 months. Of 12,592 patients those initiated on non-sulphasalazine 5-ASA (2917) had significantly higher persistence (P < 0.001) than those on sulphasalazine (9675). Persistence for sulphasalazine and non-sulphasalazine 5-ASA initiation was 22.3% and 28.5% at 12-months, and 11.9% and 16.2% at 24-months. Sulphasalazine poor persistence continued despite intra-class switch to another 5-ASA. Patients receiving immunomodulator co-therapy had higher persistence (P < 0.001). National population-based data identified persistence to 5-ASA to be low but significantly lower when sulphasalazine is the initial drug. Physicians should stress the importance of long-term 5-ASA therapy as overall drug efficacy especially the 5-ASA chemo-prophylactic benefits may be reduced by non-persistence.
Collapse
Affiliation(s)
- Christian P Selinger
- Gastroenterology and Liver Services, Concord Hospital and Bankstown Hospital, Sydney, Australia
| | | | | |
Collapse
|
42
|
Abstract
IBD often affects patients during their peak reproductive years. Several drugs are available for the treatment of IBD and new drugs are continuously in the pipeline. As long-term administration of medications is often necessary, the safety of drug therapy during pregnancy and breast-feeding needs to be considered in daily clinical practice. The aim of this Review is to summarize the latest information concerning the safety of medications used to treat IBD during pregnancy and lactation, as well as their effect on fertility. Although only thalidomide and methotrexate are absolutely contraindicated during pregnancy and breast-feeding, alternatives to ciprofloxacin, natalizumab and sodium phosphate should also be considered for pregnant women. Breast-feeding is also discouraged while on treatment with ciclosporin, metronidazole and ciprofloxacin. However, therapy with 5-aminosalicylic acid preparations, glucocorticoids, thiopurines and TNF inhibitors are acceptable during pregnancy and lactation. Pregnant women who have symptomatic IBD or who require therapy should have the opportunity to discuss any associated risks to their pregnancy and infant with the appropriate consultants. By ensuring that the patient and her family are informed, the clinical outcome might be optimized.
Collapse
Affiliation(s)
- Ole Haagen Nielsen
- Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, University of Toronto, OPG-3, 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | - Jakob Hendel
- Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| |
Collapse
|
43
|
Goodhand JR, Kamperidis N, Sirwan B, Macken L, Tshuma N, Koodun Y, Chowdhury FA, Croft NM, Direkze N, Langmead L, Irving PM, Rampton DS, Lindsay JO. Factors associated with thiopurine non-adherence in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38:1097-108. [PMID: 24099471 DOI: 10.1111/apt.12476] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 06/05/2013] [Accepted: 08/15/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Medication non-adherence seems to be a particular problem in younger patients with inflammatory bowel disease (IBD) and has a negative impact on disease outcome. AIMS To assess whether non-adherence, defined using thiopurine metabolite levels, is more common in young adults attending a transition clinic than adults with IBD and whether psychological co-morbidity is a contributing factor. We also determined the usefulness of the Modified Morisky 8-item Adherence Scale (MMAS-8) to detect non-adherence. METHODS Seventy young adults [51% (36) male] and 74 [62% (46) male] adults were included. Psychological co-morbidity was assessed using the Hospital Anxiety Depression Scale (HADS) and self-reported adherence using the MMAS-8. RESULTS Twelve percent (18/144) of the patients were non-adherent. Multivariate analysis [OR, (95% CI), P value] confirmed that being young adult [6.1 (1.7-22.5), 0.001], of lower socio-economic status [1.1 (1.0-1.1), <0.01] and reporting higher HADS-D scores [1.2 (1.0-1.4), 0.01] were associated with non-adherence. Receiver operator curve analysis of MMAS-8 scores gave an area under the curve (95% CI) of 0.85 (0.77-0.92), (P < 0.0001): using a cut-off of <6, the MMAS-8 score has a sensitivity of 94% and a specificity of 64% to predict thiopurine non-adherence. Non-adherence was associated with escalation in therapy, hospital admission and surgeries in the subsequent 6 months of follow up. CONCLUSIONS Non-adherence to thiopurines is more common in young adults with inflammatory bowel disease, and is associated with lower socio-economic status and depression. The high negative predictive value of MMAS-8 scores <6 suggests that it could be a useful screen for thiopurine non-adherence.
Collapse
Affiliation(s)
- J R Goodhand
- Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Selinger CP. Commentary: 5-ASA switches in IBD, adherence and flares. Aliment Pharmacol Ther 2013; 38:1138. [PMID: 24099475 DOI: 10.1111/apt.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 07/14/2013] [Indexed: 12/08/2022]
Affiliation(s)
- C P Selinger
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK.
| |
Collapse
|
45
|
Modifiable factors associated with nonadherence to maintenance medication for inflammatory bowel disease. Inflamm Bowel Dis 2013; 19:2199-206. [PMID: 23899547 DOI: 10.1097/mib.0b013e31829ed8a6] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Poor adherence frequently impaired the efficacy of therapy to maintain remission from inflammatory bowel diseases (IBD). There is a lack of practical and effective interventions to improve adherence. This study aimed to identify modifiable risk factors, which may yield targets for new interventions. METHODS Participants with IBD were recruited from hospital outpatient clinics and office-based gastroenterologists. Demographic and disease-related data were recorded by means of self-administered questionnaires. Modifiable risk factors were assessed with the validated Belief about Medicine Questionnaire, Hospital Anxiety and Depression Score, and short inflammatory bowel disease questionnaire. Adherence was assessed separately for 5-aminosalicylates, thiopurines, and biological agents using the validated Medicine Adherence Report Scale (good adherence defined as >16). RESULTS Nonadherence occurred in 102 of 356 participants (28.7%). Adherence increased significantly with more aggressive therapies (median Medicine Adherence Report Scale: 5-aminosalicylates 18, thiopurines 19, biological 20; P < 0.0001). Nonadherence was not associated with anxiety and depression or disease-related patient knowledge. Adherent patients had significantly higher belief of necessity for medication (P < 0.0001) and a trend toward lower concerns about medication (P = 0.08). Membership of an IBD patient organization was associated with better adherence (P < 0.0001). Concerns about medication rose significantly with more aggressive therapies (P = 0.009), but belief of necessity was similar for all medications. CONCLUSIONS Nonadherence occurs most frequently with 5-aminosalicylates. Belief of necessity may prove the key target for future interventions, although general IBD education is unlikely to yield an adherence benefit. Patient organization membership should be encouraged.
Collapse
|
46
|
Selinger CP, Kinjo Y, Jones DB, Katelaris P, Chapman G, McDonald C, Lal S, McLaughlin J, Robinson A, Leong RWL. Conveying medication benefits to ulcerative colitis patients and effects on patient attitudes regarding thresholds for adherence. J Crohns Colitis 2013; 7:e312-7. [PMID: 23219354 DOI: 10.1016/j.crohns.2012.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/19/2012] [Accepted: 11/15/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Adherence to medication that maintains remission by patients with ulcerative colitis (UC) is poor but little is known regarding patients' perception of medication benefit that may enhance adherence rates. The aims were to study patients' understanding and preference on methods of conveying statistical information and to study indicated thresholds for adherence to medication for UC. METHODS Four methods of displaying information on benefits of maintenance therapy were explained to patients with UC in remission: relative risk reduction [RR], absolute risk reduction [AR], number needed to treat [NNT] and optical representation via Cates plot [CP]. Patients' understanding and preference for each method were evaluated. Participants were asked to state minimum thresholds relating to relapse prevention and colorectal cancer risk reduction that they would require in order for them to adhere to medication for UC. RESULTS Of 50 participants, 48% preferred data presentation by RR over CP (28%), AR (20%) and NNT (4%). 94% found RR easy to understand, better than AR (88%), CP (74%), or NNT (48%). For bowel cancer prevention, 94% indicated adherence for benefit levels of 61% RR but only 57% for the corresponding CP (P<0.001). For relapse prevention, 78% of patients indicated adherence for benefit levels of 40% RR but only 43% for the corresponding CP (P<0.001). CONCLUSION Patients with UC prefer data presented by RR, and apply significantly higher thresholds for adherence when presented with CP compared to RR. Reduction of cancer risk may be a stronger motivator than maintenance of remission.
Collapse
Affiliation(s)
- Christian P Selinger
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, Sydney, NSW, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Selinger CP, Eaden J, Selby W, Jones DB, Katelaris P, Chapman G, McDondald C, McLaughlin J, Leong RWL, Lal S. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohns Colitis 2013; 7:e206-13. [PMID: 23040449 DOI: 10.1016/j.crohns.2012.09.010] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/28/2012] [Accepted: 09/10/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Enabling women with inflammatory bowel diseases (IBD) to have successful pregnancies requires complex decisions. The study aimed to assess patients' views on IBD and pregnancy and to evaluate any association with subject knowledge. METHODS General attitudes of females with IBD were assessed on fertility, medication use, delivery mode and pregnancy outcomes. Attitudes regarding personal situation were assessed in participants nulliparous since IBD diagnosis. Knowledge of pregnancy-related issues in IBD was assessed by the Crohn's and Colitis Pregnancy Knowledge Score 'CCPKnow'. RESULTS Of 145 participants 68% of participants agreed with need for medical therapy for flares during pregnancy, but 24% felt it more important to tolerate symptoms. 36% believed that all IBD medication is harmful to unborn children. Of 96 women nulliparous after IBD diagnosis, 46% were worried about infertility, 75% expressed concern about passing IBD to offspring and 30% considered not having children. Nearly all participants worried about the effects of IBD on pregnancy and the effects of pregnancy on IBD. General attitudes that 'medication should be stopped prior to conception' (P<0.001), 'pregnant women should avoid all IBD drugs' (P<0.001), and 'put up with symptoms' (P<0.001) were associated with significantly lower CCPKnow scores. CONCLUSION Over a third of patients considered IBD medication harmful to unborn children. Fear of infertility and concerns about inheritance may explain high rates of voluntary childlessness. Attitudes contrary to medical evidence were associated with significantly lower knowledge. Young women with IBD, particularly those with poor knowledge, should be offered education and counselling about pregnancy-related issues.
Collapse
Affiliation(s)
- Christian P Selinger
- Gastroenterology and Liver Services, Concord Hospital and Bankstown Hospital, Sydney, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Grover M, Drossman DA, Oxentenko AS. Direct trainee observation: opportunities for enhanced physician-patient communication and faculty development. Gastroenterology 2013; 144:1330-4. [PMID: 23623965 DOI: 10.1053/j.gastro.2013.04.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Madhusudan Grover
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | | | |
Collapse
|