Exploration of medication non-adherence in Inflammatory Bowel Disease patients: a systematic review
Tracks
Plenary Session
| Sunday, May 19, 2024 |
| 12:10 PM - 12:20 PM |
| Grand Ballroom |
Overview
Kathryn King
Speaker
Kathryn King
King’s College London
Exploration of medication non-adherence in Inflammatory Bowel Disease patients: a systematic review
Abstract
Background
Inflammatory bowel disease (IBD) has recognised medications to maintain remission and prevent relapse. Yet between 53–75% of people with IBD do not take medications as prescribed. Identifying and improving medication adherence in IBD is a primary treatment goal to keep symptoms quiescent. This systematic review aims to identify why people are adherent and non-adherent to IBD medications.
Methods
Studies exploring medication adherence for IBD conducted between 2011-2023, were identified in six electronic databases. The quality of quantitative and qualitative studies was assessed using a scoring system or the Critical Appraisal Skills Programme, respectively.
Results
35,846 participants were included across 78 studies investigating IBD medication adherence, mainly from single outpatient clinic populations, using cross-sectional surveys. Most data were quantitative, rated medium quality. Few studies were based around a theory to explain adherence.
Non-adherence was most typically measured using a version of the Morisky Medication Adherence Scale or the study’s own self-report questionnaire, with non-adherence rates ranging from 4.3% to 88.9%.
In multivariable analysis of quantitative data, younger age and female gender were usually associated with non-adherence. The presence of smoking, psychological issues (depression, treatment concerns, anxiety) or lower social status were also significant non-adherence risk factors. Most typically investigated were clinical variables, many being significantly related with non-adherence, including medication type (specifically 5-ASA), route, high and low disease activity and poor disease/medication knowledge. Significant results were often contradictory between studies, as was the relationship direction with non-adherence.
Forgetting medication was the main reason for non-adherence in qualitative interviews, with side effects, costs, medication concerns and busy lifestyle also variables. Cohort-specific factors were reported for non-adherence in pregnant women, adolescents and patients during COVID.
Conclusion
Adherence to treatment is essential in IBD. Yet a large and confusing literature exists regarding factors underpinning non-adherence. Clinicians should be aware of those non-modifiable factors, to help identify relevant patients and support their treatment programme. Potentially modifiable factors including medication regimes, route and patient knowledge, could be targeted to improve adherence in IBD. Theoretically informed interventions need to be developed.
A successful evidence-based intervention supporting medication adherence could help improve quality of life for patients living with IBD, whilst providing patient-centred care and minimising health costs.
Authors’ list:
King, K., Norton, C; Czuber-Dochan, W. & Chalder, T.
Conflict of Interest:
Norton, C. declares the following: Speaker fees from: Janssen, WebMD, Medscape, Merck Pharmaceutical; Tillotts Pharms UK. Pfizer advisory board.
King; K., Chalder, T., & Czuber-Dochan, W. declare that they have no conflict of interest.
Inflammatory bowel disease (IBD) has recognised medications to maintain remission and prevent relapse. Yet between 53–75% of people with IBD do not take medications as prescribed. Identifying and improving medication adherence in IBD is a primary treatment goal to keep symptoms quiescent. This systematic review aims to identify why people are adherent and non-adherent to IBD medications.
Methods
Studies exploring medication adherence for IBD conducted between 2011-2023, were identified in six electronic databases. The quality of quantitative and qualitative studies was assessed using a scoring system or the Critical Appraisal Skills Programme, respectively.
Results
35,846 participants were included across 78 studies investigating IBD medication adherence, mainly from single outpatient clinic populations, using cross-sectional surveys. Most data were quantitative, rated medium quality. Few studies were based around a theory to explain adherence.
Non-adherence was most typically measured using a version of the Morisky Medication Adherence Scale or the study’s own self-report questionnaire, with non-adherence rates ranging from 4.3% to 88.9%.
In multivariable analysis of quantitative data, younger age and female gender were usually associated with non-adherence. The presence of smoking, psychological issues (depression, treatment concerns, anxiety) or lower social status were also significant non-adherence risk factors. Most typically investigated were clinical variables, many being significantly related with non-adherence, including medication type (specifically 5-ASA), route, high and low disease activity and poor disease/medication knowledge. Significant results were often contradictory between studies, as was the relationship direction with non-adherence.
Forgetting medication was the main reason for non-adherence in qualitative interviews, with side effects, costs, medication concerns and busy lifestyle also variables. Cohort-specific factors were reported for non-adherence in pregnant women, adolescents and patients during COVID.
Conclusion
Adherence to treatment is essential in IBD. Yet a large and confusing literature exists regarding factors underpinning non-adherence. Clinicians should be aware of those non-modifiable factors, to help identify relevant patients and support their treatment programme. Potentially modifiable factors including medication regimes, route and patient knowledge, could be targeted to improve adherence in IBD. Theoretically informed interventions need to be developed.
A successful evidence-based intervention supporting medication adherence could help improve quality of life for patients living with IBD, whilst providing patient-centred care and minimising health costs.
Authors’ list:
King, K., Norton, C; Czuber-Dochan, W. & Chalder, T.
Conflict of Interest:
Norton, C. declares the following: Speaker fees from: Janssen, WebMD, Medscape, Merck Pharmaceutical; Tillotts Pharms UK. Pfizer advisory board.
King; K., Chalder, T., & Czuber-Dochan, W. declare that they have no conflict of interest.
Biography
With a background in Human Psychology and Adult Nursing, Kathryn King's research career began within the largest study comparing prostate cancer treatments. Multidisciplinary collaborations demonstrated to Kathryn the powerful impact nurses have on patient’s healthcare and well-being. Inspired by this project, Kathryn moved to London to train to be a nurse, introduced to more clinical practice, specifically HIV care where she worked as a qualified adult nurse thereafter.
Kathryn soon returned to Urology research to the University College London as a Research Nurse to complete her MSc. This included her Thesis “Comparing Patient Satisfaction in a One-stop Haematuria Clinic vs Urology Outpatients,” which was recommended for publication and Kathryn was advised to complete a PhD.
Kathryn was then headhunted for a £2.5million research project within the National Institute of Health Research “Supporting Uptake and Adherence to Antiretroviral Therapy.” Allow Kathryn’s to merge her nursing and psychology background, delivering Cognitive Behavioural Therapy to people struggling with adherence with a HIV diagnosis.
On completion, Kathryn’s intention was to progress further in her career, invited by King’s College London to lead the new MSc Programme in Adult Nursing. During this time, she networked, identifying colleagues interested in supporting her to complete her PhD and in 2022, she was awarded a prestigious NIHR doctoral fellowship to support people living with IBD with adherence issues.
Since starting her fellowship, she has presented her research at ECCO 2023 and 2024 conference, the NZSG and NZgNC Annual Scientific Meeting and King’s College London Postgraduate Research conferences. Kathryn has also published her Scoping review “What Do We Know about Medication Adherence Interventions in Inflammatory Bowel Disease, Multiple Sclerosis and Rheumatoid Arthritis: A Scoping review of RCTs” and is in process of completing her next publication; “Factors associated with Medication Non-adherence in IBD Patients: A Systematic Review.”
