title: Identifying predictors of low adherence in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Inflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring medical therapy to maintain clinical remission. Low adherence to therapy leads to poorer disease outcome. Therefore, we aimed to identify predictors of low adherence in the Belgian IBD population.
  
  
  METHODS
  Between November 2013 and March 2014, 570 ambulatory patients (471 patients with IBD and 99 non-IBD controls) visiting a tertiary IBD-referral centre were requested to complete the Morisky 8-Item Medication Adherence Scale (MMAS-8) questionnaire as well as a survey of sociodemographic data (smoking, educational level, marital status and occupation). On the basis of the self-reported MMAS questionnaire, adherence was categorized as low (MMAS-8 score: >2), medium (MMAS-8 score: 1-2) or high (MMAS-8 score: 0).
  
  
  RESULTS
  The response rate in the IBD population was as high as 99%. Low adherence was reported less frequently in the IBD population than in the non-IBD controls (36 vs. 49%, P=0.021). In multivariate analysis, factors associated independently with low adherence in the IBD population were age younger than 40 [odds ratio: 1.589 (95% confidence interval: 1.057-2.389), P=0.026], higher educational level [1.961 (1.305-2.946), P=0.001], being single [1.641 (1.020-2.639), P=0.041] and the use of mesalamine [1.591 (1.018-2.487), P=0.041]. Self-employment was identified as a protective factor for low adherence [0.397 (0.167-0.946), P=0.041].
  
  
  CONCLUSIONS
  Approximately one-third of the IBD patients were low adherers. Predictors of low adherence were aged younger than 40 years, higher educational level, being single and mesalamine use, whereas being self-employed was a protective factor. On the basis of these data, personalized algorithms may be developed to improve patient education, empowerment and follow-up.
authors.affiliation: aDepartment of Gastroenterology, University Hospitals Leuven bTranslational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven cMACX, Integrated Care, Aartselaar, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Coenen
authors.forename: Ellen
authors.initials: E
authors.lastname: Weyts
authors.forename: Vera
authors.initials: V
authors.lastname: Ballet
authors.forename: Maja
authors.initials: M
authors.lastname: Noman
authors.forename: Gert
authors.initials: G
authors.lastname: Van Assche
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
authors.forename: Jan
authors.initials: J
authors.lastname: Van Emelen
authors.forename: Marc
authors.initials: M
authors.lastname: Ferrante
mesh_terms: D000328:Adult; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001530:Belgium; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004522:Educational Status; D004651:Employment; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D065840:Protective Factors; D012307:Risk Factors; D012847:Single Person; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D019804:Mesalamine