Soobraty Anisah, Boughdady Sarah, Selinger Christian P
Anisah Soobraty, Sarah Boughdady, Christian P Selinger, IBD Unit, Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom.
World J Gastrointest Pharmacol Ther. 2017 Feb 6;8(1):67-73. doi: 10.4292/wjgpt.v8.i1.67.
The survey ascertains perceptions and describes current practice of clinicians regarding medication non-adherence in patients with Inflammatory Bowel Disease.
Gastroenterologists, trainees and inflammatory bowel disease (IBD) specialist nurses from the United Kingdom were invited to a web based survey collecting data on clinician demographics, patient volume and level of interest in IBD. Respondents were asked to estimate non-adherence levels and report use of screening tools and interventions to improve adherence.
Non-adherence was seen as an infrequent problem by 57% of 98 respondents. Levels of non-adherence were estimated lower than evidence suggests by 29% for mesalazine (5ASA), 26% for immunomodulators (IMM) and 21% for biologics (BIOL). Respondents reporting non-adherence as a frequent problem were more likely to report adherence levels in line with evidence (5ASA < 0.001; IMM = 0.012; BIOL = 0.015). While 80% regarded screening as important only 25% screen regularly (40% of these with validated assessment tools). Respondents stated forgetfulness, beliefs about necessity of medication and not immediately apparent benefits as the main reasons for non-adherence. Patient counselling on benefits and risks of medication was a commonly used intervention.
Clinicians treating IBD patients frequently underestimate non-adherence and use of validated screening tools is infrequent. Most respondents identified the main factors associated with non-adherence in line with evidence and often counselled patients accordingly. Professional education should focus more on non-adherence practice to avoid adverse treatment outcomes associated with non-adherence.
本调查旨在确定临床医生对炎症性肠病患者药物治疗不依从性的看法，并描述当前的实践情况。
邀请来自英国的胃肠病学家、实习医生和炎症性肠病（IBD）专科护士参与一项基于网络的调查，收集有关临床医生人口统计学、患者数量以及对IBD的兴趣程度的数据。受访者被要求估计不依从水平，并报告使用筛查工具和干预措施以提高依从性的情况。
98名受访者中有57%认为不依从是一个不常见的问题。估计的不依从水平低于证据显示的水平，美沙拉嗪（5-氨基水杨酸）低29%，免疫调节剂低26%，生物制剂低21%。将不依从视为常见问题的受访者更有可能报告与证据相符的依从水平（5-氨基水杨酸<0.001；免疫调节剂=0.012；生物制剂=0.015）。虽然80%的人认为筛查很重要，但只有25%的人定期进行筛查（其中40%使用经过验证的评估工具）。受访者指出，遗忘、对药物必要性的看法以及没有立竿见影的益处是不依从的主要原因。对患者进行药物益处和风险的咨询是常用的干预措施。
治疗IBD患者的临床医生经常低估不依从性，且很少使用经过验证的筛查工具。大多数受访者根据证据确定了与不依从相关的主要因素，并经常据此为患者提供咨询。专业教育应更多地关注不依从性的实践，以避免与不依从相关的不良治疗结果。
