title: Rates and Reasons for Nonuse of Prescription Medication for Inflammatory Bowel Disease in a Referral Clinic.
abstract: BACKGROUND
  We aimed to determine the rates and reasons for nonuse of inflammatory bowel disease (IBD)-specific medication in a referral clinic.
  
  
  METHODS
  Consecutive persons with Crohn's disease (CD) (n = 423) and ulcerative colitis (UC) (n = 342) were followed in a single clinic over 2 years. At each patient visit, it was determined whether and what type of IBD-specific medications were used at that visit. If medications were not used, the reason for nonuse was recorded. Disease remission, further stratified by "clinical remission" and "deep remission" (clinical remission plus imaging evidence of remission), was considered a reason for nonuse if the attending physician believed the person was in remission and agreed for them to be off medications.
  
  
  RESULTS
  Nonuse of IBD-specific medication was seen in 121 persons with CD (29%) and 65 persons with UC (18%). In CD, increased age and disease duration were associated with nonuse; disease phenotype did not predict nonuse. In UC, disease duration was associated with nonuse but age was not. In CD, the most common reason for medication nonuse was deep remission (22.5%), followed by clinical remission (21.4%), not having seen a gastroenterologist for a lengthy period (21.4%) and nonadherence (16%). In UC, nonuse was attributed to deep remission (27.7%), followed by nonadherence (26.3%) and clinical remission (23%).
  
  
  CONCLUSIONS
  Approximately a quarter of persons with IBD attending at a tertiary care practice do not use IBD-specific medications with a higher rate in CD than UC. The decision not to use medications was deemed appropriate in approximately one-half of all nonusers.
authors.affiliation: *Department of Internal Medicine, Section of Gastroenterology, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada; and †IBD Unit, Department of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Sanchit
authors.initials: S
authors.lastname: Bhasin
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.forename: Laura E
authors.initials: LE
authors.lastname: Targownik
authors.forename: Eran
authors.initials: E
authors.lastname: Israeli
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012017:Referral and Consultation; D012074:Remission Induction; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D016903:Drug Monitoring