Conveying medication benefits to ulcerative colitis patients and effects on patient attitudes regarding thresholds for adherence

Acceptability of a 'treat to target' approach in inflammatory bowel disease to patients in clinical remission

BACKGROUND

A 'treat to target' approach aiming for remission of clinical symptoms and absence of mucosal inflammation has been proposed in inflammatory bowel disease (IBD). We aimed to establish whether patients with IBD in clinical remission find this approach acceptable.

METHODS

Patients in glucocorticosteroid-free clinical remission underwent a face-to-face structured, quantitative interview and rated the acceptability of treat to target on a 10-point Likert scale. We analysed factors associated with agreement to treat to target.

RESULTS

The cohort comprised 298 patients (144 Crohn's disease, 136 ulcerative colitis, 18 IBD-unclassified). Elevated C-reactive protein was found in 24.4% and elevated faecal calprotectin in 17.7%. Overall, 66.2% of patients rated a treat to target approach as acceptable (Likert scale ≥8). Acceptable treatment aims for patients were avoidance of flare, hospitalisation, surgery and colorectal cancer. Using binary logistic regression analysis the following were not predictive of accepting a treat to target approach: age, diagnosis, disease phenotype, surgical history, disease duration, patient knowledge, adherence, anxiety, depression and patient-reported control of disease. Better adherence to current therapy was associated with accepting a treat to target approach (B=0.16, p=0.039).

CONCLUSION

In a cohort of patients in clinical remission, where this strategy is most relevant, two-thirds of patients agreed with treat to target. Patients with better current adherence were more likely to accept treat to target. Patient education and counselling materials will need to be developed to convince a substantial minority of patients of the importance of treat to target.

Effect of format on comprehension of adherence data in chronic disease: A cross-sectional study in HIV

OBJECTIVE

To determine which formats communicate medication adherence effectively to patients.

METHODS

HIV-infected adults on antiretrovirals viewed examples of refill data in 5 formats: (1) percentage of doses, (2) number of days late to refill ("days late"), (3) calendar of days with/without medications, (4) pie chart of days with/without medications, and (5) letter grade. Five scenarios (>95%, 90-95%, <90%, <80% and <70% adherence) were presented in each format. Participants rated scenarios on adherence improvement needed. "Good understanding" was ≥ 4 of 5 scenarios correct. We calculated odds ratios for "good understanding" using logistic regression with percentage as the referent format.

RESULTS

124 participants were median age 48.5 years, 65% Black, 71% male. Understanding of all formats differed by education (all interaction p values<0.02). For ≤ 12 years education, odds ratios (OR) of understanding (95% CI) compared to percentage were: days late 3.3 (2.3-4.7), calendar 3.1 (2.2-4.3) pie chart 2.0 (1.4-2.7), and letter grade 1.8 (1.3-2.5). For >12 years education, ORs were: days late 1.3 (0.9-2.0), calendar 2.4 (1.5-3.8), pie chart 2.9 (1.8-4.6), and letter grade 1.7 (1.1-2.6). Calendar plot was most preferred.

CONCLUSIONS

Adherence percentage was the least understood format regardless of education.

PRACTICE IMPLICATIONS

Calendars should be used to convey adherence information.