Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Schubert-Martin Inflammatory Bowel Disease Center.
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr Gastroenterol Nutr. 2019 Nov;69(5):564-569. doi: 10.1097/MPG.0000000000002431.
Among adolescents with inflammatory bowel disease (IBD), nonadherence rates are 50 to 88% across medications. Improving education in adults with IBD has been shown to improve coping and adherence to treatment in adults with IBD. Therapeutic patient education (TPE) has been used in patients with chronic diseases to train patients in skills to support treatment adaptation and condition management. This study tested the feasibility and preliminary efficacy of a novel TPE intervention in adolescents with IBD.
In this pilot, mixed-methods study, we evaluated the feasibility and preliminary efficacy of TPE with the IBD Pocket Guide on medication adherence, IBD knowledge, and transition readiness in adolescents ages 11 to 18 years. Medication adherence was monitored using a MedMinder Pill Dispensing system. Participants who were <90% adherent during a 4-week pre-intervention monitoring period were randomized to either a usual care group or an educational intervention (EI) group. Participants were followed for an additional 4 weeks after intervention.
Trends were found in the EI group indicating improved medication adherence and IBD knowledge compared with the usual care group, though differences between groups did not reach statistical significance. Qualitative data showed that participants perceived that they had improved knowledge after the educational intervention.
Therapeutic patient education may be beneficial for improving patient medication adherence and IBD knowledge. Future directions include testing the effects of the intervention with a larger sample.
在患有炎症性肠病 (IBD) 的青少年中,药物治疗的不依从率为 50%至 88%。研究表明,提高成年人对 IBD 的认识可以改善成年人应对疾病和治疗的依从性。治疗性患者教育 (TPE) 已在慢性疾病患者中使用,以培训患者掌握支持治疗适应和疾病管理的技能。本研究测试了一种新型 TPE 干预措施在 IBD 青少年中的可行性和初步疗效。
在这项试点、混合方法研究中,我们评估了 IBD 袖珍指南对青少年(11 至 18 岁)药物依从性、IBD 知识和过渡准备的 TPE 的可行性和初步疗效。通过 MedMinder 药丸分配系统监测药物依从性。在 4 周的干预前监测期内,依从性<90%的参与者被随机分配到常规护理组或教育干预 (EI) 组。干预后,参与者再随访 4 周。
EI 组的趋势表明,与常规护理组相比,药物依从性和 IBD 知识有所提高,但组间差异没有达到统计学意义。定性数据显示,参与者认为他们在接受教育干预后知识有所提高。
治疗性患者教育可能有助于提高患者的药物依从性和 IBD 知识。未来的方向包括用更大的样本测试干预措施的效果。