Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2017; 8(1): 67-73
Published online Feb 6, 2017. doi: 10.4292/wjgpt.v8.i1.67
Current practice and clinicians’ perception of medication non-adherence in patients with inflammatory bowel disease: A survey of 98 clinicians
Anisah Soobraty, Sarah Boughdady, Christian P Selinger
Anisah Soobraty, Sarah Boughdady, Christian P Selinger, IBD Unit, Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
Christian P Selinger, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds LS9 7TF, United Kingdom
Author contributions: Soobraty A and Boughdady S collected the data, performed the analysis and wrote the draft manuscript; Selinger CP designed the study, supervised data collection and analysis and critically reviewed the manuscript.
Institutional review board statement: The study was exempt from the requirement of research ethics committee approval as no patient data were elicited.
Informed consent statement: All study participants provided informed consent by return of the online questionnaire.
Conflict-of-interest statement: Christian P Selinger has received unrestricted research grants from Warner Chilcott, and Abbvie, has provided consultancy to Warner Chilcott, Dr Falk, Abbvie, Takeda and Janssen, and had speaker arrangements with Warner Chilcott, Dr Falk, Abbvie, MSD and Takeda; the other authors report no relevant conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Christian P Selinger, IBD Unit, Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Beckett St., Leeds LS9 7TF, United Kingdom. christian.selinger@web.de
Telephone: +44-113-2068768
Received: October 17, 2016
Peer-review started: October 19, 2016
First decision: November 22, 2016
Revised: November 24, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: February 6, 2017
Processing time: 94 Days and 23.9 Hours
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.

Keywords: Non-adherence; Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Clinical practice

Core tip: Non-adherence to maintenance medication is a very common phenomenon occurring in up to 50% of patients with inflammatory bowel disease. This survey demonstrates that many clinicians underestimate the extent of non-adherence and screening for non-adherence is infrequent and not systematic. The lack of evidence for any intervention to improve adherence is reflected by the participants divergent practice to improve adherence. There is an urgent need for further clinician education on non-adherence and robustly tested interventions that are capable of improving adherence.