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PREDICTORS OF MEDICATION ADHERENCE IN INFLAMMATORY BOWEL DISEASE PATIENTS AT THE STOLLERY CHILDREN'S HOSPITAL
L Kitney, J Turner, D Spady, B Malik, W El-Matary, R Persad, H HuynhUniversity of Alberta, Edmonton, Alberta
Aims: This study was undertaken to examine self reported adherence rates in Inflammatory Bowel Disease (IBD) patients at the Stollery Children's Hospital and to determine predictors of medication adherence.
Methods: IBD patients at the Stollery Children's Hospital were asked to complete a mail-out survey between May and August 2008. The survey included demographics and twenty-five questions regarding medication adherence to anti-inflammatory medications and micronutrient supplements/complementary medicines. Adherence was defined as reporting taking medicines more than 80% of the time. In addition, a chart review was completed for those who completed the survey. Information was also collected from the IBD patient database for those that did not respond to the survey, the non-responders.
Results: The total study population of this IBD clinic was 212 patients. One hundred and nineteen patients completed the survey. In comparison to responders, the non-responders were not significantly different in gender, disease duration or type. Non-responders were significantly older than responders (14.5yrs vs. 13.2yrs; p=0.032). The overall adherence rate was reported to be 80%. Non-adherence was associated with older adolescents (14.6 vs. 13.0; p= 0.04); longer disease duration (5.0yrs vs. 3.1yrs; p=0.004) and reported use of herbal medications (40.0% versus 13.6% P=0.029). There was also a trend toward non-adherence in those with a parent/guardian education level of high school or lower (31.2% vs. 13.2%, p = 0.075); The most common reasons reported for missing medications were forgetfulness, feeling better and too many medications. Patients reported being most likely to take anti-inflammatory medications and least likely to take herbal medicines. The average number of gastroenterology appointments in the last year was also found to predict adherence with 4.0 yearly appointments in the adherent group versus 1.6 in the non-adherent group (P=0.001).
Conclusions: Pediatric IBD patients at the Stollery Children's Hospital report an 80% adherence rate. Identified predictors of non-adherence such as age, disease duration and use of herbal treatments may enable us to develop specific strategies to improve adherence in this population. In particular, targeted strategies to the adolescent age group would seem to be warranted.