Relationship Between Patient Knowledge and Medication Adherence in Inflammatory Bowel Disease

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To the Editor:
Despite advances in pharmacologic and surgical treatment strategies, patients' understanding and knowledge of their inflammatory bowel disease (IBD) varies widely and has lagged behind such advances despite current gastrointestinal evidence-based guidelines that underscore the importance of patient education.1 Patients' understanding of their disease processes correlates with better outcomes in many chronic relapsing and remitting illnesses. The aim of this study was to see whether a correlation exists between patients' knowledge of inflammatory bowel disease and medication adherence, as perceived by both the patient and the physician.
Two hundred one consecutive outpatients at one academic Crohn's and Colitis Center (University of Miami, Miami, FL) enrolled. All patients completed the validated 24-question Crohn's and Colitis Knowledge Score (CCKNOW)2 and a 3-question Medication Adherence Questionnaire (MAQ)3 survey (3; maximum adherence) at an office visit waiting to see a provider. Physicians then completed a validated Clinical Rating Scale,4 scored 1 to 7 (maximum adherence), to assess their perception of the patients' medication adherence after the visit encounter.
Two hundred one patients completed the study, 87 men (43.3%) and 114 women (56.7%). Disease type included the following: 122 (60.7%) Crohn's disease, 68 (33.8%) ulcerative colitis, 11 (5.5%) indeterminate. Mean age was 40.2 ± 15.1 years. Mean overall survey scores were as follows: CCKNOW 10.94 ± 4.98 of 24, MAQ 2.28 ± 0.88 of 3, and Clinical Rating Scale 6.07 ± 1.16 of 7. No baseline differences in mean CCKNOW scores were noted between either sex or type of disease. No statistically significant differences were noted in the mean inflammatory bowel disease knowledge of patients as assessed by the overall CCKNOW scores for different levels of medication adherence as assessed by the overall MAQ in total, by individual MAQ questions, or by the Clinical Rating Scale score (Table 1).
To conclude, our study results suggest that no association between patients' disease knowledge and patient or physician perception of medication adherence exists. Regardless, higher knowledge has yet to show significant positive association with key objective clinical parameters, such as colorectal cancer risk or intestinal inflammation (as measured by fecal calprotectin).5 As greater knowledge of disease seems to positively impact other chronic relapsing and remitting illnesses, research investigating other factors contributing to optimal medication adherence should be undertaken.

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