Abstract
Background
Inflammatory Bowel Disease (IBD) refers to Ulcerative colitis (UC) or Crohn’s disease (CD) and is a global problem, affecting over five million people worldwide. Rates of IBD have been reported to be particularly high in New Zealand (NZ). With no cure available, medical treatment to induce remission is the goal. Adherence to medical therapy is often low in patients with IBD. This can lead to increased symptoms for the patient which impacts on daily social activities, as well as their ability to work and be productive. It also has significant financial implications for health care systems, as ongoing disease flares can result in more complications requiring hospital admissions, surgeries and increased outpatient care.
Aim
This research sought to determine rates of medication adherence in an NZ adult IBD population, as well as exploring general beliefs about medicines. In doing this, I was able to find common themes with international data, and from there infer possible reasons for non-adherence.
Methodology
This cross-sectional study used an anonymous online questionnaire to ask IBD patients questions regarding medication adherence, and beliefs about medication generally. The questions in the online survey included two existing and previously validated tools to screen for adherence, and to ascertain medication beliefs. These were the Modified Morisky Assessment Scale (MMAS) that had been further modified by Trindade et al. (2011) to be used specifically in IBD, and the Beliefs about Medicines Questionnaire (BMQ). In addition to these, various demographic questions were asked to help describe the study cohort, and to compare with NZ Census data to draw conclusions about whether this sample was representative of an adult NZ population.
Results
The results of 337 included questionnaire responses showed that rates of adherence to prescribed medications in an adult IBD population in NZ, are at least as low as, or lower than, those reported in the international literature. The statistically significant variables associated with higher rates of adherence were; NZ European ethnicity, increased age, diagnosis of CD, and beliefs regarding general overuse of medicines. The variables associated with poorer adherence were; tertiary education, diagnosis of UC, non-NZ European ethnicity and concerns about adverse effects of medicines outweighing belief about their necessity.
Discussion
The results from this study aligned with the findings from previous international studies. The implications of these results for clinical practice are discussed in the context of changes that can be made to IBD care to improve adherence. This research showed that patients who are younger and educated to a higher level, are more likely to be non-adherent, as are those of a non-NZ European ethnicity. It also showed that beliefs about medication and concerns about adverse effects, are significantly associated with non-adherence.
Conclusion
The data collected from this study helps to define the problem of non-adherence in a NZ population. From here, further research will enable interventions to be formulated to address the specific concerns about medications and other variables found to be significant in this study. Interventions must be planned in a way that makes them relevant and accessible to all IBD patients. This study has highlighted issues and this information can be used to improve the way that we discuss medical therapy with our patients. For example, medication and health information must be delivered in an appropriate manner. This may be printed or online information in languages other than English, or using web-based apps which are very familiar to the younger population.