Introduction Non-adherence to IBD maintenance medication occurs in 30–45% with mesalazine (5 ASA), 15–20% with immunomodulators (IMM), 5–10% with biologics (BIOL); yet clinicians struggle to detect and address non-adherence. Little is known how clinicians perceive the issue of non-adherence and how they address adherence questions (screening and interventions). This survey ascertains perceptions and describes current practice.
Methods Consultant gastroenterologists, trainees and IBD specialist nurses from the UK were invited to a web based survey. Data were collected on clinician demographics, patient volume and level of interest in IBD. We assessed perception of non-adherence by overall impression and asked respondents to estimate non-adherence for 5 ASA, IMM and BIOL therapy. Current practice assessment included use of screening tools and interventions to improve adherence.
Results Of 98 respondents (53.1% were female, 53.1% < 44 years) 51 were consultants, 17 trainees, 28 IBD specialist nurses and 2 other. Half of respondents had ≥15 years’ experience. Medical staff were classed as general gastroenterologists (43%), having IBD interest (32%) and IBD experts (25%).
Non-adherence was seen as an infrequent problem by 57%. Older respondents saw non-adherence as an infrequent problem more often (p = 0.006). The level of non-adherence was estimated as lower than evidence suggests by 31% of respondents for 5 ASA, 28% for IMM and 23% for BIOL. Respondents reporting non-adherence to be a frequent problem were more likely to report adherence levels in line with established evidence (5 ASA p < 0.001; IMM p = 0.012; BIOL p = 0.015). Gender, age, years of practice, level of interest, professional status (consultant vs trainee vs nurse), and patient volume did not influence the likelihood of estimating adherence levels in line with the evidence.
Respondents stated forgetfulness, beliefs about necessity of medication and not immediately apparent benefits as the main reasons for non-adherence.
While 80% regarded screening as important only 25% screen regularly. Only 40% used validated assessment tools. Patient counselling on benefits and risks of medication was the most commonly used intervention.
Conclusion Clinicians treating IBD patients frequently underestimate non-adherence and use of validated screening tools is infrequent. This phenomenon occurs across grades and professions. Most respondents identified the main factors associated with non-adherence in line with evidence and counselled patients accordingly. Professional education should focus more on non-adherence practice to avoid adverse treatment outcomes associated with non-adherence.
Disclosure of Interest S. Boughdady: None Declared, A. Soobraty: None Declared, C. Selinger Grant/research support from: Abbie, Warner Chilcott, Consultant for: Abbie, Warner Chilcott, Dr Falk, Takeda, Speaker bureau with: Abbie, Warner Chilcott, MSD, Takeda