title: A triangulation study of the clinician and patient experiences of the use of the immunosuppressant drugs azathioprine and 6-mercaptopurine for the management of inflammatory bowel disease.
abstract: OBJECTIVE
  The aim of this study was to explore the service for patients with inflammatory bowel disease taking or having taken azathioprine or 6-mercaptopurine in the last three years, at two District General Hospitals within the same Trust.
  
  
  BACKGROUND
  Published data confirm that the use of azathioprine and 6-mercaptopurine is effective in the control of inflammatory bowel disease. However, there are inconsistencies in dosing regimes, blood monitoring and duration of therapy. Regimes used have been largely based on clinicians' personal preference leading to inconsistencies in practice.
  
  
  METHODS
  A questionnaire, designed to elicit the experience of treatment regimes, blood monitoring and access to information was sent to 130 patients taking or having taken azathioprine or 6-mercaptopurine in the last three years. A further questionnaire was sent to 94 general practitioners and interviews were conducted with 10 hospital doctors initiating treatment.
  
  
  RESULTS
  The study demonstrated lack of clarity in the prescribing methods, the monitoring regimes being offered, variation in information given to patients and consequent patient knowledge.
  
  
  CONCLUSIONS
  Azathioprine and 6-mercaptopurine are increasingly being used successfully in inflammatory bowel disease, sparing the use of steroids and maintaining remission over a longer period. A review of the current literature has informed and made possible a suggested blood-monitoring regime.
  
  
  CONCLUSIONS
  The adoption of a protocol-led service, managed by the nurse specialist, incorporating guided self-management by patients should be considered. A shared-care approach with the patient and general practitioner with rapid access to secondary care would provide a robust system.
authors.affiliation: Gastroenterology, Cheltenham General Hospital, Cheltenham, UK. karen.holbrook@glos.nhs.uk
authors.forename: Karen
authors.initials: K
authors.lastname: Holbrook
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001379:Azathioprine / Q000627:therapeutic use*; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D017723:Drug Utilization Review; D004739:England; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000523:psychology; D008505:Medical Staff, Hospital / Q000523:psychology; D015122:Mercaptopurine / Q000627:therapeutic use*; D009720:Nurse Clinicians / Q000458:organization & administration; D015404:Nursing Methodology Research; D010353:Patient Education as Topic; D018579:Patient Selection; D010821:Physicians, Family / Q000458:organization & administration / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine