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Patient Education in a 14-month Randomised Trial Fails to Improve Adherence in Ulcerative Colitis: Influence of Demographic and Clinical Parameters on Non-adherence.
Patient Education in a 14-month Randomised Trial Fails to Improve Adherence in Ulcerative Colitis: Influence of Demographic and Clinical Parameters on Non-adherence.
- Source :
-
Journal of Crohn's & colitis [J Crohns Colitis] 2017 Sep 01; Vol. 11 (9), pp. 1052-1062. - Publication Year :
- 2017
-
Abstract
- Background and Aim: Recent observational studies document that non-adherence to mesalamine therapy during remission is frequent. We aimed to investigate patient impact of patient education using objective assessments of adherence.<br />Methods: A 14-month randomised, prospective clinical trial of adherence to mesalamine was conducted in 248 patients with ulcerative colitis [UC], Colitis Activity Index [CAI] ≤ 9, receiving standard care [n = 122] versus a standardised patient education programme [n = 126]. Primary endpoint was adherence at all visits (5-aminosalicylic acid [5-ASA] urine levels). Secondary endpoints included quality of life (inflammatory bowel disease questionnaise [IBDQ]), disease activity, partial adherence, and self-assessment of adherence.<br />Results: Patient allocation was well balanced. Baseline non-adherence was high in quiescent/mildly active UC [52.4%] without difference between the groups (52.4% of patients in the education group versus 52.5% in the standard care group [p = 0.99]). No difference between the intervention group and standard care was seen in IBDQ, partial adherence, self-assessment of adherence, or therapy satisfaction at all visits. We suggest a model in which individual risks for non-adherence are driven by patients with young age, short disease duration, and low education levels.<br />Conclusions: Non-adherence is frequent in a population with quiescent/mildly active UC. Although more than 25% of the population was not in remission at the various time points, no relationship between disease activity and adherence was seen over the 14-month observation period. Physicians should maximise their efforts to motivate high-risk patients for adherence. Future trials should use objective exposure assessments to examine the impact of continuous education and consultations on the background of individual risks to develop non-adherence.<br /> (Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Colitis, Ulcerative psychology
Female
Follow-Up Studies
Humans
Logistic Models
Male
Medication Adherence psychology
Middle Aged
Prospective Studies
Quality of Life
Treatment Outcome
Young Adult
Anti-Inflammatory Agents, Non-Steroidal therapeutic use
Colitis, Ulcerative drug therapy
Mesalamine therapeutic use
Patient Education as Topic
Assessment of Medication Adherence
Subjects
Details
- Language :
- English
- ISSN :
- 1876-4479
- Volume :
- 11
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Journal of Crohn's & colitis
- Publication Type :
- Academic Journal
- Accession number :
- 28486634
- Full Text :
- https://doi.org/10.1093/ecco-jcc/jjx062