Rectal medication compliance in adolescents with inflammatory bowel disease.

Abstract

BACKGROUND AND AIMS: Low compliance rates have been found in IBD patients with regards to maintenance therapy. We proposed to identify barriers to compliance with rectal medications in pediatric IBD patients. METHODS: A 30 question survey was performed in adolescent patients (12-21 years) and their parents regardless of previous medication use. Questions included demographics such as current age, age at diagnosis, diagnosis, and ethnicity. A history of their disease was established with respect to surgical management and time of most recent colonoscopy. Current disease activity was assessed with questions regarding abdominal pain, stools, and function. The remainder of the survey determined the rate of compliance with respect to rectal medications and identified the barriers to compliance with ranging from physician-patient communication to adverse effects. Subjects who had never used rectal medications answered questions about whether they would consider using of the medications and what potential concerns were. RESULTS: Preliminary data showed the mean age of diagnosis is 13y and the mean age at time of survey completion of 16y. 85% of respondents had Crohn's disease and 15% had ulcerative colitis. 80% reported low disease activity and a high quality of life, as assessed with frequency and severity of symptoms, as well as function. 80% of patients have been hospitalized secondary to their IBD. 50% of patients have had surgery in the past. 80% reported being compliant "some of the time" with rectal medications. The most commonly identified barrier to adherence was not liking the sensation (75%). 20% of patients were prescribed oral medications while on rectal medications. 95% of patients reported they would not or did not take the medication at school. The responses of adolescent patients were compared to their parents with respect to compliance rates and barriers to compliance. Parents reported 95% compliance rate compared to the 80% reported by adolescent patients. Parents and patients both identified disliking the sensation as the most common barrier to adherence. CONCLUSION: Identifying barriers to compliance with rectal medications among teens is important when considering medication options.