title: Clinical impact and drivers of non-adherence to maintenance medication for inflammatory bowel disease.
abstract: BACKGROUND
  Inflammatory bowel diseases (IBDs) require maintenance medication to sustain remission and as a prophylaxis against the development of colorectal dysplasia. Non-adherence can compromise the effectiveness of treatment plans.
  
  
  METHODS
  Depending on study cohort and country, 7 - 72% of IBD patients do not adhere to maintenance medication plans. Non-adherence is associated with an increased number of flares and increased healthcare utilization costs. Several factors, such as experiencing side effects and demographic, socioeconomic, disease-specific and psychological variables have been associated with non-adherence in IBD. Data on demographic, socioeconomic and disease-specific variables are inconsistent, while data on psychological distress, patients' beliefs about medication and discordant doctor-patient relationships are more consistently associated with non-adherence. There has been a change towards investigation of modifiable factors for non-adherence in the recent literature.
  
  
  CONCLUSIONS
  Currently, there is no simple and effective intervention to improve adherence to IBD maintenance medication. Anxiety, beliefs about medicines and the doctor-patient relationship are promising targets for interventions, but require further study.
authors.affiliation: Gastroenterology, Salford Royal Hospital, Salford, UK. Christian.selinger@web.de
authors.forename: Christian P
authors.initials: CP
authors.lastname: Selinger
authors.forename: Andrew
authors.initials: A
authors.lastname: Robinson
authors.forename: Rupert W
authors.initials: RW
authors.lastname: Leong
mesh_terms: D015331:Cohort Studies; D017048:Health Care Costs; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D055118:Medication Adherence; D010817:Physician-Patient Relations; D016896:Treatment Outcome; D016312:Treatment Refusal