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      Medication adherence in inflammatory bowel disease

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          Abstract

          Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.

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          Concurrent and predictive validity of a self-reported measure of medication adherence.

          D E Morisky, L Green, D Levine (1986)
          Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
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            Predictive validity of a medication adherence measure in an outpatient setting.

            Donald E. Morisky, Alfonso Ang, Marie Krousel-Wood … (2008)
            This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.
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              Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice.

              K C Farmer (1999)
              Researchers and clinicians have used numerous methods in their attempts to adequately assess patient compliance (adherence) with medication regimens and to identify noncompliant patients. Large variations have been reported in the extent of noncompliance in individual patients and large populations. In addition, nonadherence has often been poorly defined. Direct measures of adherence include drug assays of blood or urine, use of drug markers with the target medication, and direct observation of the patient receiving the medication. Indirect measures of adherence imply that the medication has been used by the patient; these measures include various forms of self-reporting by the patient, medication measurement (pill count), use of electronic monitoring devices, and review of prescription records and claims. Compliance measures should be assessed on the basis of their validity (sensitivity and specificity or statistical correlation) and the reference standard used. Many early studies used pill counts as a reference standard, but electronic monitoring devices such as the Medication Event Monitoring System have replaced pill counts as the reference standard. The choice of a method for measuring adherence to a medication regimen should be based on the usefulness and reliability of the method in light of the researcher's or clinician's goals. Specific methods may be more applicable to certain situations, depending on the type of adherence being assessed, the precision required, and the intended application of the results.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Intest Res
                Journal ID (iso-abbrev): Intest Res
                Journal ID (publisher-id): IR
                Title: Intestinal Research
                Publisher: Korean Association for the Study of Intestinal Diseases
                ISSN (Print): 1598-9100
                ISSN (Electronic): 2288-1956
                Publication date (Print): October 2017
                Publication date (Electronic): 23 October 2017
                Volume: 15
                Issue: 4
                Pages: 434-445
                Affiliations
                [1 ]Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia.
                [2 ]Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
                [3 ]South Western Sydney Clinical School, University of New South Wales, Australia.
                [4 ]Sydney Medical School, the University of Sydney, Sydney, Australia.
                [5 ]IBD Unit, Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK.
                Author notes
                Correspondence to Webber Chan, Gastroenterology and Liver Services, Concord Repatriation General Hospital, ACE Unit, Level 1 West, Hospital Road Concord NSW 2139, Australia. Tel: +61-2-9767-6111, Fax: +61-2-9767-6767, webber.chan.p.w@ 123456singhealth.com.sg
                Article
                DOI: 10.5217/ir.2017.15.4.434
                PMC ID: 5683974
                PubMed ID: 29142511
                SO-VID: 55c71a50-1c4b-451f-bef3-79e40c30b02d
                Copyright © © Copyright 2017. Korean Association for the Study of Intestinal Diseases.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 May 2017
                Date revision received : 28 May 2017
                Date accepted : 29 May 2017
                Categories
                Subject: Review

                Keywords: medication adherence,colitis, ulcerative,crohn disease,inflammatory bowel disease
                Data availability:
                Keywords: medication adherence, colitis, ulcerative, crohn disease, inflammatory bowel disease

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