Coenen Sofie, Weyts Ellen, Ballet Vera, Noman Maja, Van Assche Gert, Vermeire Séverine, Van Emelen Jan, Ferrante Marc
aDepartment of Gastroenterology, University Hospitals Leuven bTranslational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven cMACX, Integrated Care, Aartselaar, Belgium.
Eur J Gastroenterol Hepatol. 2016 May;28(5):503-7. doi: 10.1097/MEG.0000000000000570.
Inflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring medical therapy to maintain clinical remission. Low adherence to therapy leads to poorer disease outcome. Therefore, we aimed to identify predictors of low adherence in the Belgian IBD population.
Between November 2013 and March 2014, 570 ambulatory patients (471 patients with IBD and 99 non-IBD controls) visiting a tertiary IBD-referral centre were requested to complete the Morisky 8-Item Medication Adherence Scale (MMAS-8) questionnaire as well as a survey of sociodemographic data (smoking, educational level, marital status and occupation). On the basis of the self-reported MMAS questionnaire, adherence was categorized as low (MMAS-8 score: >2), medium (MMAS-8 score: 1-2) or high (MMAS-8 score: 0).
The response rate in the IBD population was as high as 99%. Low adherence was reported less frequently in the IBD population than in the non-IBD controls (36 vs. 49%, P=0.021). In multivariate analysis, factors associated independently with low adherence in the IBD population were age younger than 40 [odds ratio: 1.589 (95% confidence interval: 1.057-2.389), P=0.026], higher educational level [1.961 (1.305-2.946), P=0.001], being single [1.641 (1.020-2.639), P=0.041] and the use of mesalamine [1.591 (1.018-2.487), P=0.041]. Self-employment was identified as a protective factor for low adherence [0.397 (0.167-0.946), P=0.041].
Approximately one-third of the IBD patients were low adherers. Predictors of low adherence were aged younger than 40 years, higher educational level, being single and mesalamine use, whereas being self-employed was a protective factor. On the basis of these data, personalized algorithms may be developed to improve patient education, empowerment and follow-up.
炎症性肠病（IBD）是需要药物治疗以维持临床缓解的慢性胃肠道疾病。治疗依从性低会导致疾病预后较差。因此，我们旨在确定比利时IBD患者群体中低依从性的预测因素。
在2013年11月至2014年3月期间，要求570名到三级IBD转诊中心就诊的门诊患者（471例IBD患者和99例非IBD对照）完成Morisky 8项药物依从性量表（MMAS-8）问卷以及社会人口学数据（吸烟、教育水平、婚姻状况和职业）调查。根据自我报告的MMAS问卷，依从性分为低（MMAS-8评分：>2）、中（MMAS-8评分：1-2）或高（MMAS-8评分：0）。
IBD患者群体的应答率高达99%。IBD患者群体中报告的低依从性发生率低于非IBD对照（36%对49%，P=0.021）。在多变量分析中，IBD患者群体中与低依从性独立相关的因素为年龄小于40岁[比值比：1.589（95%置信区间：1.057-2.389），P=0.026]、教育水平较高[1.961（1.305-2.946），P=0.001]、单身[1.641（1.020-2.639），P=0.041]以及使用美沙拉嗪[1.591（1.018-2.487），P=0.041]。个体经营被确定为低依从性的保护因素[0.397（0.167-0.946），P=0.041]。
约三分之一的IBD患者为低依从者。低依从性的预测因素为年龄小于40岁、教育水平较高、单身和美沙拉嗪的使用，而个体经营是一个保护因素。基于这些数据，可开发个性化算法以改善患者教育、赋权和随访。
