Background: Adherence is generally associated with improved treatment outcome in patients with IBD and is estimated to be between 30–60%. Capturing non adherence in daily practice remains a challenge. Risk factors for non-adherence are still contradictory. The study aimed to identify risk factors for non- adherence in IBD patients
Methods: All participants filled questionnaires including: demographic, clinical, socioeconomic data and accessibility to GI services. Psychological features were assessed using: Sense of Coherence, Hospital Anxiety and Depression Scale, IBD self-efficacy scale and Brief Illness Perception questionnaires. Adherence to treatment was evaluated using the Morisky (8 questions) score.
Results: This study included 224 patients; 64.3% females, median age 37 years (IQR 27–44). Of them 70% had Crohn's disease (CD), 25% Ulcerative colitis (UC) and 5% undetermined colitis. A third of UC and 20% of CD patients had an extensive disease. Seventy percent had at least 1 hospitalization, 33% underwent at least one operation and 50% received biological treatment. Backward multivariate regression analysis demonstrated that high adherence was associated with biological treatment (OR 0.33; 95% CI 0.135–0.784, p=0.012) and depression (OR 0.1; 95% CI 0.26–0.415, p=0.001). Low adherence was associated with anxiety (OR 3.43; 95% CI 1.47–7.98, p=0.004) and past smoking (OR 6.95; 95% CI 1.59–30.42, p=0.010). Marital status and number of medications taken by the patient were not associated with adherence. Type of disease, time from symptoms, age, gender, employment, use of 5-ASA, hospitalization and severity of disease score were associated with adherence in the univariate analysis but not in the multivariate analysis.
Conclusions: Psychological factors (depression or anxiety) as well as disease related factors (biological treatment and smoking status) can strongly influence adherence status in IBD patients.