title: Barriers to mesalamine adherence in patients with inflammatory bowel disease: a qualitative analysis.
abstract: BACKGROUND
  The causes for nonadherence to mesalamine in patients with inflammatory bowel disease (IBD) have been characterized using mostly indirect methods. Patient-reported barriers are lacking in this population.
  
  
  OBJECTIVE
  To identify patient-reported barriers to mesalamine adherence through direct interviews.
  
  
  METHODS
  Focus groups and one-on-one interviews were undertaken in adult patients with IBD. Transcripts from the focus groups and interviews were analyzed to identify themes and links between these themes, assisted by qualitative data software MaxQDA.
  
  
  RESULTS
  Of 27 patients participating, 21 (78%) had ulcerative colitis, and 6 (22%) had Crohn's disease. Their self-reported adherence ranged from complete adherence (n = 3) to intermittent nonadherence (n = 24). Patients frequently indicated that they were resistant to taking medications for their condition. The barriers to adherence that emerged from interviews could be categorized under a number of themes: competing priorities, social stigma, refill inconvenience, costs, efficacy values, side effects, and pill characteristics. Efficacy values reported to influence adherence included doubts about efficacy, consequences of missed doses, and doubts about need for maintenance medication. Pill characteristics reported as barriers included pill size and pill frequency. Despite use of electronic prescribing, obtaining refills was reported as an obstacle to adherence in this cohort. Decanting of pills to multiple containers to increase accessibility was also reported.
  
  
  CONCLUSIONS
  Patients with both ulcerative colitis and Crohn's disease report a number of common barriers to mesalamine adherence. Factors in medication-taking behavior and beliefs were reported in this study that may have implications for strategies to improve adherence by health care providers.
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 022156, USA. amoss@bidmc.harvard.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Devlen
authors.forename: Kathleen
authors.initials: K
authors.lastname: Beusterien
authors.forename: Linnette
authors.initials: L
authors.lastname: Yen
authors.forename: Awais
authors.initials: A
authors.lastname: Ahmed
authors.forename: Adam S
authors.initials: AS
authors.lastname: Cheifetz
authors.forename: Alan C
authors.initials: AC
authors.lastname: Moss
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine