Patient nonadherence to medication in inflammatory bowel disease.
OBJECTIVE
The aim of this study was to identify determinants of nonadherence to medication in outpatients with established inflammatory bowel disease (IBD).


METHODS
Ten gastroenterologists and 153 of their IBD patients participated in this prospective study. Demographic, clinical, and psychosocial characteristics, as well as patient-physician discordance, were assessed at an office visit. Nonadherence to medication was assessed 2 wk later. Separate generalized estimating equations were used to identify determinants of nonadherence.


RESULTS
Physicians averaged 47.9 yr in age (range 30.1-57.5 yr), and 90% were male. Patients averaged 37.0 yr (SD = 15.1), and 87 (56.9%) were female. In all, 63 patients (41.2%) were nonadherent to medication; of these, 51 (81.0%) indicated unintentional nonadherence, 23 (36.5%) intentional nonadherence, and 11 (17.5%) both. Overall nonadherence was predicted by disease activity (OR = 0.55, p = 0.0022), new patient status (OR = 2.14, p = 0.0394), disease duration (OR = 0.50, p = 0.0001), and scheduling a follow-up appointment (OR = 0.30, p = 0.0059), whereas higher discordance on well-being was predictive only in psychologically nondistressed patients (p = 0.0026 for interaction). Unintentional nonadherence was predicted by age (OR = 0.97, p = 0.0072), new patient status (OR = 2.80, p = 0239), and higher discordance on well-being in psychologically nondistressed patients (p = 0.0504). Intentional nonadherence was predicted by disease duration (OR = 0.55, p = 0032), scheduling a follow-up appointment (OR = 0.12, p = 0.0001), certainty that medication would be helpful (OR = 0.99, p = 0.0409), and total patient-physician discordance (OR = 1.59, p =.0120).


CONCLUSIONS
These findings suggest that the therapeutic relationship, as well as individual clinical and psychosocial characteristics, influence adherence to medication.
Sewitch
Maida J
MJ
Groupe de Recherche Interdisciplinaire en Santé, University of Montreal, Montreal, Quebec, Canada.
Abrahamowicz
Michal
M
Barkun
Alan
A
Bitton
Alain
A
Wild
Gary E
GE
Cohen
Albert
A
Dobkin
Patricia L
PL
D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000523:psychology*; D003424:Crohn Disease / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D010817:Physician-Patient Relations; D011446:Prospective Studies; D016312:Treatment Refusal / Q000523:psychology
D019804:Mesalamine