Telephone nurse counseling for medication adherence in ulcerative colitis: a preliminary study.
OBJECTIVE
Adherence is challenging in episodic chronic conditions that require medication during both symptomatic and quiescent periods, such as ulcerative colitis (UC). Adherence for these conditions is under-studied. This study was a preliminary test of telephone nurse counseling to address cognitive and emotional barriers to adherence in UC.


METHODS
524 people taking mesalamine for UC were referred by their health care providers, and 278 (53%) enrolled. There were no demographic differences between program participants and nonparticipants. Participants reported multiple comorbidities and concomitant medications. All participants received telephone follow-up (M = 2.1 calls) from a registered nurse who used cognitive-behavioral and motivational interviewing counseling techniques. Adherence measured by structured interview was compared to a population baseline using a binomial test.


RESULTS
Attrition was 51% over 6 months but was unrelated to adherence. Participants had better adherence than the expected population rate, with a significant dose-response effect. Reasons for nonadherence were primarily psychological or efficacy-related.


CONCLUSIONS
Adherence following intervention was better than typical mesalamine adherence. Self-efficacy predicted adherence, but demographic and clinical variables did not. Adherent participants reported more adverse events.


CONCLUSIONS
Attention to patients' cognitive and emotional reactions may help to improve adherence in episodic chronic diseases such as UC.
Cook
Paul F
PF
University of Colorado Denver, College of Nursing, Aurora, CO 80045, USA. Paul.Cook@ucdenver.edu
Emiliozzi
Suzie
S
El-Hajj
Dana
D
McCabe
Mishcha M
MM
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D003071:Cognition; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000523:psychology; D003376:Counseling / Q000379:methods*; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D019804:Mesalamine / Q000008:administration & dosage*; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation; D055502:Secondary Prevention; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D055817:Telenursing / Q000458:organization & administration*; D013689:Telephone; D016312:Treatment Refusal / Q000523:psychology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine