Background: Medication adherence is pivotal to the optimal management of inflammatory bowel disease (IBD) patients and this could be influenced by various patient related factors independent of disease course. This study aims to evaluate the impact of patient reported outcomes, coping strategies and psychosocial factors on adherence.
Methods: We conducted a cross-sectional study on patients with Crohn's disease (CD) or ulcerative colitis (UC) at McGill IBD centre between September 2015 and March 2016. Patients were assessed for quality of life, disability and productivity using validated short IBD questionnaire (SIBDQ), IBD disability index (IBDDI) and work productivity assessment index (WPAI) respectively. Psychological assessment was performed using hospital anxiety and depression score (HADS). Brief COPE questionnaire were used for assessing coping strategies. Disease activity was determined by Harvey Bradshaw index (HBI >4) and partial Mayo score (PMS>2). Medication adherence was evaluated using the medication adherence questionnaire (poor adherence defined as MAQ>2) and the treating physician also independently provided their perception of individual patient adherence. Results were examined using descriptive and regression analysis.
Results: 207 (144 CD/63 UC) patients, with median age of 39 (IQR 26) and 42.5% male, were included. 24.2% of patients had clinically active disease. 23.2% of patients were on immunomodulators and 52.7% on biologic therapy. Around one third of patients identified moderate to severe impairment on disability (31.3%), quality of life (33.3%) and productivity (29.1%); along with some degree of anxiety (32.9%) and depression (23.3%). Poor adherence was reported by 29.5% of patients and it is inadequately identified by treating physicians (r=0.19, p=0.009). Patients with poor quality of life, anxiety, depression and maladaptive coping behaviours were less likely to be adherent to therapy on univariate analysis (Table 1). Conversely adherence is associated with older age, biologic use, and marital status. Disease activity, duration, disability, education, employment and insurance status were not significantly associated with adherence. Age, marital status, biologic use and maladaptive behaviour remain significant on multi-variate analysis.
Conclusions: Selected patient characteristics and reported outcomes including age, biologic use, marital status and maladaptive behaviour may help to identify those patients at risk of medication non-adherence.