PILOT INTERVENTION TO IMPROVE MEDICATION ADHERENCE IN NONADHERENT INFLAMMATORY BOWEL DISEASE PATIENTS

Abstract

Purpose: The purpose of this study is to assess current medication adherencerates and evaluate the feasibility of a continuous self improvement (CSI) interventionin adult nonadherent inflammatory bowel disease (IBD) participants via electronicmonitoring (EM) in a mid-western IBD clinic.SUMMARIZED DESCRIPTION OF THE PROJECT: In the United States, 1.4 millionpeople have been diagnosed with IBD. The medication regimen for IBD is complexand lifelong, which has shown to increase medication nonadherence rates.IBD medication nonadherence ranges from 7-72%, with no demographic, treatmentor clinical factors consistently predicting nonadherence. IBD medicationnonadherence leads to suboptimal control of the disease, decreased quality of life, and increased healthcare utilization and costs. Five intervention studies attemptingto enhance IBD medication adherence have resulted in virtually no improvement inadherence. CSI is an innovative personal system-based intervention. Through dataevaluation and system refinement processes, personal system changes are identifiedand implemented. As adherent behavior becomes habitual, less energy, motivation, and intention are required to maintain adherence.DESIGN: Pilot randomized controlled trial. Methods: Nineteen adult IBD participants screened for medication nonadherencevia electronic monitoring for 2-months. The medication adherence score capturesthe variability in medication dosing and timing. A window of time was used to determinemedication adherence which then allowed calculation of a medication adherencescore. The 'on time' window was calculated as +/- 25% of the prescribed medicationdosing interval; 'early' or 'late' window was +/- 50%, and 'missed' window ascalculated as a dose not taken within +/- 50% of the prescribed time. This calculationapproach had been successfully used on once /twice daily dosed medications in previousstudies. Feedback on the screening EM data was delivered by the primary investigator(PI), sharing how the current personal system creates the nonadherence.The PI guided the participant through the CSI process, identifying established routines/systems where medication taking could be enhanced for the next 3-months.Feasibility/acceptability of the intervention will be evaluated along with medicationadherence change scores in the CSI group after the 3-month study. Results/ConclusionS: Of the 19 participants completing the screening period, nine participants were found to be nonadherent (47.4%) with medication adherencescore less than 0.85; three nonadherent participants did not complete thestudy as one was taken off immunosuppressive medications, and two were lostto follow-up. Six participants were randomized, four participants to CSI and twoparticipants to attention control. CSI feasibility and medication adherence scoresare pending. CSI may be a feasible intervention to improve medication adherencein adult IBD patients. A fully powered study is needed to examine the effect ofCSI on maintenance medication adherence in adult IBD patients.