Ediger JP, Walker JR, Graff L, et al.. Predictors of medication adherence in inflammatory bowel disease

University of Manitoba, Winnipeg, Manitoba, Canada
The American Journal of Gastroenterology (Impact Factor: 10.76). 08/2007; 102(7):1417-26. DOI: 10.1111/j.1572-0241.2007.01212.x
Source: PubMed


This study reports cross-sectional medication adherence data from year 1 of the Manitoba Inflammatory Bowel Disease (IBD) Cohort Study, a longitudinal, population-based study of multiple determinants of health outcomes in IBD in those diagnosed within 7 yr.
A total of 326 participants completed a validated multi-item self-report measure of adherence, which assesses a range of adherence behaviors. Demographic, clinical, and psycho-social characteristics were also assessed by survey. Adherence was initially considered as a continuous variable and then categorized as high or low adherence for logistic regression analysis to determine predictors of adherence behavior.
Using the cutoff score of 20/25 on the Medication Adherence Report Scale, high adherence was reported by 73% of men and 63% of women. For men, predictors of low adherence included diagnosis (UC: OR 4.42, 95% CI 1.66-11.75) and employment status (employed: OR 11.27, 95% CI 2.05-62.08). For women, predictors of low adherence included younger age (under 30 versus over 50 OR 3.64, 95% CI 1.41-9.43; under 30 vs. 40-49 yr: OR 2.62, 95% CI 1.07-6.42). High scores on the Obstacles to Medication Use Scale strongly related to low adherence for both men (OR 4.05, 95% CI 1.40-11.70) and women (OR 3.89, 95% CI 1.90-7.99). 5-ASA use (oral or rectal) was not related to adherence. For women, immunosuppressant use versus no use was associated with high adherence (OR 4.49, 95% CI 1.58-12.76). Low trait agreeableness was associated with low adherence (OR 2.03, 95% CI 1.12-3.66).
Approximately one-third of IBD patients were low adherers. Predictors of adherence differed markedly between genders, although obstacles such as medication cost were relevant for both men and women.

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Available from: Norine Miller, Sep 02, 2014
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    • "The data were collected from September 2009 until March 2012. Patients with inflammatory bowel disease (IBD) were identified as a target population for the pre-tests as high rates of poor medication intake behavior among this patient group have been reported [22]. In the pre-tests eight nurses of six different Dutch hospitals participated. "
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    ABSTRACT: OBJECTIVE: To describe the development of a theoretical and evidence-based tailored multimedia intervention to improve medication intake behavior in patients with inflammatory bowel disease (IBD). The intervention integrates interpersonal and technology-mediated strategies with the expectation that this will work synergistically. METHODS: The development followed the Medical Research Council's framework. Three literature reviews and three pre-tests among 84 IBD patients and eight nurses were conducted to guide the development of the intervention. A feasibility study was carried out among four nurses and 29 patients. RESULTS: The components include: (1) an online preparatory assessment (OPA); (2) tailored interpersonal communication; and (3) tailored text messaging. To support the development, the feasibility was tested. Results indicated that the OPA was comprehensive and could be a helpful tool for both patients and nurses to prepare for the consultation. The training was evaluated as being instructive and applicable with a mean mark of 8.5. Of the developed messages, 65.6% received positive evaluations and were used in the intervention. CONCLUSION: By applying the framework, we were able to describe the logic behind the development of a tailored multimedia intervention to improve medication intake behavior. PRACTICE IMPLICATIONS: This study could serve as a guide for the development of other health interventions.
    Full-text · Article · Apr 2013 · Patient Education and Counseling
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    • "Participants were asked to complete the Medication Adherence Report Scale (MARS). The MARS has been used as a self-reported measure of adherence in a number of chronic diseases, including chronic obstructive pulmonary disease,38 asthma,39 chronic pain management in cancer,40 bipolar disorder,17 and inflammatory bowel disease.41,42 The MARS includes a preamble encouraging honest responses. "
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    ABSTRACT: Beliefs about medicines impact on adherence, but eliciting core beliefs about medicines in individual patients is difficult. One method that has the potential to elicit individual core beliefs is the "repertory grid technique." This study utilized the repertory grid technique to elicit individuals' beliefs about their heart failure treatment and to investigate whether generated constructs were different between adherent and nonadherent patients. Ninety-two patients with heart failure were interviewed using a structured questionnaire that applied the repertory grid technique. Patients were asked to compare and contrast their medicines and self-care activities for their heart failure. This lead to the generation of individual constructs (perceptions towards medicines), and from these, beliefs were elicited about their heart failure treatment, resulting in the generation of a repertory grid. Adherence was measured using the Medication Adherence Report Scale (MARS). Patients with a MARS score ≥ 23 were categorized as "adherent" and those with a score ≤ 22 as "nonadherent." The generated grids were analyzed descriptively and constructs from all grids themed and the frequency of these constructs compared between adherent and nonadherent patients. Individual grids provided insight into the different beliefs that patients held about their heart failure treatment. The themed constructs "related to water," "affect the heart," "related to weight," and "benefit to the heart" occurred more frequently in adherent patients compared with nonadherent patients. The repertory grid technique elicited beliefs of individual participants about the treatment of their heart failure. Constructs from self-reported adherent patients were more likely to reflect that their medicines and self-care activities were related to water and weight, and affect and benefit to the heart. Providing clinicians with better insight into individuals' beliefs about their treatment may facilitate the development of tailored interventions to improve adherence.
    Full-text · Article · Feb 2013 · Patient Preference and Adherence
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    • "Also patients in the Kane et al. study were younger than patients in the current study (51 vs. 55 years old). However, another study by Kane et al. demonstrated that females decreased persistence at 3 months [27] while Ediger et al. showed that younger females were less adherent than older males [29]. This latter study also reported that predictors of adherence differed markedly between the sexes. "
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    ABSTRACT: Background Although high non-adherence to medication has been noticed for ulcerative colitis (UC), little is known about adherence to mesalamine treatments and determinants that can predict adherence. The objective of this study was to assess adherence and persistence to mesalamine treatments and their potential determinants in mild to moderate UC patients in a real-life setting in Quebec, Canada. Methods A retrospective prescription and medical claims analysis was conducted using a random sample of mesalamine users with UC. For inclusion, patients were required to initiate an oral mesalamine treatment between January 2005 and December 2009. Patients with a diagnosis of Crohn’s disease were excluded. Treatment adherence (medication possession ratio [MPR]) and persistence were evaluated over a 1-year period after the index prescription using the Kaplan-Meier method with log-rank test and stepwise regression to identify potential determinants. Results A sample of 1,681 of the new oral mesalamine users (mean age = 55.3) patients was obtained. Overall, the percentage of patients with a MPR of 80% or greater at 12 months was 27.7%, while persistence was 45.5%. Among patients treated with mesalamine delayed/extended-release tablets (Mezavant®), adherence and persistence were 40.9% and 71.9%, respectively. Predictors of high adherence included, male gender (OR=1.3; 95% confidence interval [CI]=1.1–1.6), older age (>60 years; OR=1.6; 95% CI=1.3–2.0) and current use of corticosteroids (OR=1.4; 95% CI=1.1–1.8). Predictors of high persistence included male sex (OR=1.4; 95% CI=1.1–1.7), current use of corticosteroids (OR=1.4; 95% CI=1.1–1.7) and presence of hypertension or respiratory diseases (OR=1.2; 95% CI=1.01–1.55). Conclusions The majority of patients with UC exhibited low adherence and persistence to mesalamine treatments. Various determinants of improved adherence and persistence were identified.
    Full-text · Article · Jan 2013 · BMC Gastroenterology
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