Improving maintenance medication adherence in adult inflammatory bowel disease patients: a pilot study
Medication nonadherence in inflammatory bowel disease (IBD) may lead to suboptimal control of the disease, decreased quality of life, and poor outcomes. This pilot study evaluated the feasibility, intervention mechanism, and potential effectiveness of a three-month con tinuous self-improvement (CSI) intervention to enhance medication adherence (MA) in adult nonadherent IBD patients. Adult IBD patients taking a daily or twice-daily dosed maintenance medication were screened elec tronically for two months to determine base line MA levels. Nonadherent IBD participants were randomized to the CSI or the attention control (AC) intervention and monitored for three months. The CSI intervention consisted of a data evaluation and system refinement process in which system changes were identi fied and implemented. The AC group was given educational information regarding IBD dis ease process, extra-intestinal manifestations of IBD, and medical therapy. Demographic sta tistics, change scores for within and between group differences, and effect size estimates were calculated. Nine nonadherent partici pants (medication adherence score <0.85) were eligible for randomization. The interven tion was found feasible and acceptable. Although no statistically significant improve ment in MA was found (P=0.14), adherence improved in 3 of 4 of the CSI group and 1 of 2 in the attention control group. The effect size calculation of 1.9 will determine the sample size for future study. The results of this pilot study showed the intervention was feasible and had a positive effect on MA change score and adherence levels. A larger fully powered study is needed to test of the effectiveness of this innovative intervention.
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