Psycho-social predictors of noncompliance with chronic drug treatment in Crohn's disease and Ulcerative Colitis

Doron Schwartz, Batel Lasry, Moataz Abo Abod, Dan Greenberg, Michael Friger, Elena Chernin, Hillel Vardi, Orly Sarid, Vered Slonim-Nevo, Selwyn H. Odes

Research output: Contribution to journalMeeting Abstract

Abstract

Background & Aims: Crohn's disease (CD) and Ulcerative Colitis (UC) are chronic diseases requiring maintenance therapy to prevent relapse and further complications. Compliance with treatment is associated with improved outcomes. We aimed to identify psycho-social factors associated with noncompliance to chronic drug treatment. Methods: From the electronic adult patient database of the gastroenterology department of a large tertiary care
hospital we identified 128 CD and 101 UC patients receiving maintenance treatment for one year (6 months before and 6 months after study enrollment). These patients were contacted and filled in their demographics, economic status, disease activity (Harvey Bradshaw Index (P-HBI) for CD, Simple Clinical Colitis Activity Index (SCCAI) for UC), Brief Symptom Inventory (psychological stress score, GSI), Brief COPE Inventory (coping strategies), SF-36 (quality-of-life Physical Health (PH) and Mental Health (MH) scores), and SIBDQ. For each patient, drug refill information for the study period was obtained from computerized pharmacy records. Compliance was defined as at least 80% acquisition of prescribed medication. Univariate analysis and regression models were used to identify
significant associations for compliance. Nonparametric data are medians (IQR). Results: There were 78 (61% of total) CD and 59 (53.15%) UC noncompliant patients. Age, gender, education, disease duration and coping strategies were not related to compliance. CD noncompliant patients as compared with UC were more likely to be unemployed (CD 47.4% vs. UC 28.6%, p=0.035), had "poor" economic status (30.3% vs. 8.5%, p=0.004), had active disease (54.2% vs. 27.9%, p=0.006), lower SIBDQ score (44 (IQR 9—68) vs. 53 (20—70), p=0.004), higher GSI (0.42 (0—2.39) vs. 0.23 (0—1.68), p=0.009), and lower SF-36 Physical
Health (44.1 (14.1—65.9) vs. 46.7 (25.7—60.1), p=0.03). UC noncompliance was associated with non-smoking (UC 98.3% vs. CD 85.7%, p=-.013). Quantile regression models (Figures) revealed further differences between CD and UC patients. Conclusion: Psycho-social predictors of noncompliance were different in CD and UC patients. While CD compliance was associated with unemployment, poverty, psychological stress and less physical health, UC noncompliance was only associated with non-smoking.
Original languageEnglish GB
Pages (from-to)S795-S795
JournalGastroenterology
Volume152
Issue number5
DOIs
StatePublished - Apr 2017

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