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Overcoming adherence issues in ulcerative colitis.

ABSTRACT: Ulcerative colitis (UC) is a chronic condition requiring lifelong medication to minimize the incidence of symptomatic flares. Nevertheless, studies have shown that a large proportion of patients are nonadherent to their prescribed therapeutic regimen. This review examines studies of patient adherence to 5-aminosalicylic acid (5-ASA) therapy in real world settings and considers the reasons that patients do not adhere to medication. Patients offer numerous reasons for not taking medication as prescribed; however, neither clinical nor community studies have consistently identified the same groups of patients as being high risk for poor adherence. Indeed, the problem of nonadherence is complex and requires a combination of strategies to be improved. Physicians, physician assistants, and nurse practitioners need to take the time to explain the importance of continual therapy, even when patients feel well, and should engage patients in a discussion to aid in the understanding of their nonadherence. Then, healthcare providers can determine how to best amend the regimen to improve adherence. As taking several tablets several times daily may be confusing or difficult for patients, higher strength 5-ASA formulations that require fewer daily doses have the potential to enhance patient adherence as part of an overall management strategy.

SUBMITTER: Kane SV

PROVIDER: S-EPMC3104162 | biostudies-other | 2007 Oct

REPOSITORIES: biostudies-other

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Overcoming adherence issues in ulcerative colitis.

Kane Sunanda V SV

Gastroenterology & hepatology 20071001 10

Ulcerative colitis (UC) is a chronic condition requiring lifelong medication to minimize the incidence of symptomatic flares. Nevertheless, studies have shown that a large proportion of patients are nonadherent to their prescribed therapeutic regimen. This review examines studies of patient adherence to 5-aminosalicylic acid (5-ASA) therapy in real world settings and considers the reasons that patients do not adhere to medication. Patients offer numerous reasons for not taking medication as pres ...[more]

PMID: 21960790

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Project description:AimsEvaluate the impact of an intervention program in non-adherent patients with ulcerative colitis.MethodsParallel controlled randomized clinical trial (1:1), approved by the ethics committee (No. 3.068.511/2018) and registered at The Brazilian Clinical Trials Registry (No. RBR-79dn4k). Non-adherent ulcerative colitis patients according to the Morisky-Green-Levine-test were included. Recruitment began in August 2019 until August 2020, with 6-month follow-up. All participants received standard usual care, and additionally the intervention group received educational (video, educational leaflet, verbal guidance) and behavioral interventions (therapeutic scheme, motivational and reminder type short message services). Researchers were blinded for allocation prior to data collection at Visits 1 and 2 (0 and 6 months). Primary outcome: 180-day adherence rate, with relative risk 95%CI. Secondary outcome: 180-day quality of life according to SF-36 domains, using Student's t test. Variables with p<0.20 were selected for regression. Analysis included data from August/2019 to May/2021.ResultsForty-six and 49 participants were allocated in control and intervention groups, respectively. Two were excluded due to intervention refusal, and 4 and 6 were lost to follow-up in control and intervention groups. There was no post-intervention adherence rate difference, even after adjustment for type of non-adherence (unintentional/both/intentional) as confounder, or if considered as adherent the intervention group participants lost in follow-up. Interventions promoted better quality of life scores even after multivariate analysis for "Pain", when adjusted for ulcerative colitis severity, sex, and marital status (β = 18.352, p = 0.004), "Vitality", when adjusted for ulcerative colitis severity (β = 10.568, p = 0.015) and "Emotional Aspects", when adjusted for disease severity, income, and education (β = 24.907, p = 0.041).ConclusionsThe intervention program was not able to produce a significant medication adherence rate difference between comparative groups, however, there was a significant improvement in quality of life. Study limitations may include: sample size calculated to identify differences of 30%, leading to a possible insufficient power; non blinded participants, exposing the results to the risk of performance bias; outcomes based on self-reported data.

Dataset Information

Overcoming adherence issues in ulcerative colitis.

Publications

Overcoming adherence issues in ulcerative colitis.

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