Improving Medication Adherence in Inflammatory Bowel Disease

Written by Tim Mickleborough BSP, RPh, MEd

Pharmacists know first-hand how difficult it can be for patients to take their medications as prescribed. In fact, medication nonadherence to long-term treatment can reach up to 50 per cent in patients with chronic diseases such as diabetes, hypertension, and asthma.

Nonadherence can take on many forms, such as:

  • Not filling an initial or existing prescription;
  • Discontinuing a course of medication prematurely;
  • Taking more or less medication than prescribed; and
  • Forgetting to take a dose or taking a dose at the incorrect time.

Medication nonadherence can result in suboptimal management of chronic conditions, resulting in increased health care costs.

The extent of medication nonadherence in inflammatory bowel disease (IBD) may approach that for other chronic diseases, with nonadherence occurring in 30-45 per cent of IBD patients. This is associated with negative therapeutic outcomes such as relapse, loss of response to medication, higher morbidity and mortality, increased health care costs, and higher disability.

It may be difficult for pharmacists to identify which of their patients with IBD are more likely to be nonadherent. Research suggests the following factors possibly contribute to nonadherence:

  • younger patients;
  • shorter disease duration;
  • milder disease severity;
  • concomitant medications;
  • presence of concomitant depression or anxiety;
  • longer duration of time between clinic visits for IBD; and
  • limited knowledge of medications.

Pharmacists should be familiar with a variety of strategies that are used to promote medication adherence; a multi-faceted approach may be useful. Pharmacist counselling addressing misperceptions, concerns, and risks related to medications has been shown to improve medication adherence in patients with IBD. Educational interventions that discuss dosing and side effects of IBD medications have shown to improve adherence.  Behavioral interventions can be used to target unintentional nonadherence, which is defined as forgetfulness or obstacles in taking medications. Pharmacists can help change patient behaviors by providing audio or visual reminders, supplying weekly pill boxes, and simplifying dosage regimens to once daily dosing. Pharmacists should also be familiar with motivational interviewing, where the pharmacist uses a patient-centered, nonjudgmental, empathetic approach to encourage the patient’s own motivation to engage in positive behavior changes.

Pharmacists can detect nonadherence by reviewing a patient’s profile for late refills and yearly medication reviews provide opportunities to discuss patient concerns. Pharmacists need to use open-ended, nonjudgmental questions when asking about nonadherence to avoid the impression that they are blaming the patient.

Examples of questions that may encourage dialogue about nonadherence include:

  • People often have difficulty taking their medication for one reason or another, have you had any difficulty taking your medication?
  • How often would you say you miss taking your medication?

Adherence to a medication regimen plays a significant role in the successful management of chronic diseases and IBD is no exception.

Since IBD affects patients of many ages, pharmacists need to intervene not only with patients but also caregivers and parents. Appropriate interventions such as education, strategies to change medication taking behavior, and motivational interviewing can help increase adherence and ultimately improve therapeutic outcomes and lower health care costs.

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