Review article: Understanding adherence to medication in ulcerative colitis - Innovative thinking and evolving concepts

Abstract

Background Non-adherence to medication is an important challenge in the treatment of ulcerative colitis (UC). Epidemiological studies have demonstrated that non-adherence affects 40-60% of UC patients, and has a substantial impact on the course of the disease. In one study, non-adherence was associated with a five-fold increase in the risk of relapse. Aim We review factors contributing to non-adherence to UC therapy, and emerging concepts in addressing the problem. MethodsA search of the published literature on adherence to medication, combined with the authors' knowledge of the field. Results Adherence is a complex, multifactorial issue, with factors varying between patients and changing over time. Identifying patients at risk of non-adher ence is a key first step in targeting interventions to improve adherence. However, investigations of single factors that affect adherence have provided conflicting evidence. Evaluating physical and perceptual barriers to adherence, and acknowledging the role of patients' beliefs and concerns regarding treatment provide valuable insights into the causes of non-adherence. This allows development of targeted interventions to improve adherence to UC therapy. Clinical tools to identify patients at risk of non-adherence are being developed to facilitate this approach. Conclusions To help patients adhere better to maintenance therapy for UC, it is vital to consider patients' beliefs and concerns, and to evaluate and address both physical and perceptual barriers to adherence. © 2010 Blackwell Publishing Ltd.