title: Rates and predictors of oral medication adherence in pediatric patients with IBD.
abstract: BACKGROUND
  Symptoms of inflammatory bowel disease (IBD) include bloody diarrhea, fatigue, abdominal pain, and weight loss. Long-term management of remission for most patients requires adherence to taking 1 or more oral medications daily, in the absence of symptoms. We investigated whether disease characteristics and behavioral characteristics predict adherence to prescribed medical regimens.
  
  
  METHODS
  : Patients aged 8 to 17.5 years, newly diagnosed with IBD, and a matched cohort previously diagnosed were studied over a 6-month period. Adherence was assessed using medication electronic monitoring devices (Medication Event Monitoring Systems); participants and parents completed questionnaires regarding emotional and behavioral functioning, and biological parameters were monitored.
  
  
  RESULTS
  : Adherence was monitored for 45 newly and 34 previously diagnosed patients. In total, 16,478 patient-days (including 12,066 discrete days) were electronically monitored. Overall, 70.6% of 5-aminosalicylic acid and 65.4% of 6-mercaptopurine doses were taken. Only 25% and 15% of older adolescents took at least 80% of their 5-aminosalicylic acid and 6-mercaptopurine, respectively, compared with about 83% and 64% of 8-year-olds to 11-year-olds. Only age and behavioral issues were statistically linked to rates of adherence.
  
  
  CONCLUSIONS
  Adherence to commonly prescribed oral medications for IBD is challenging for patients. Screening for emotional and behavioral problems, especially among older adolescents, would be important in identifying patients at risk of poor adherence, who might benefit from interventions. Biological solutions, although critical, when applied without attention to behavioral issues, are not likely to provide the level of therapeutic benefit that can be provided in a combined biobehavioral approach.
authors: Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence RI 02903, USA. neal_leleiko@brown.edu
authors: Neal S
authors: NS
authors: LeLeiko
authors: Debra
authors: D
authors: Lobato
authors: Sarah
authors: S
authors: Hagin
authors: Elizabeth
authors: E
authors: McQuaid
authors: Ronald
authors: R
authors: Seifer
authors: Sheryl J
authors: SJ
authors: Kopel
authors: Julie
authors: J
authors: Boergers
authors: Jack
authors: J
authors: Nassau
authors: Kristina
authors: K
authors: Suorsa
authors: Jason
authors: J
authors: Shapiro
authors: Barbara
authors: B
authors: Bancroft
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000523:psychology*; D003424:Crohn Disease / Q000188:drug therapy / Q000523:psychology*; D019468:Disease Management; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage*; D019804:Mesalamine / Q000008:administration & dosage*; D010349:Patient Compliance; D011379:Prognosis; D011795:Surveys and Questionnaires
chemical_list: D019804:Mesalamine; D015122:Mercaptopurine