Re-phrasing the question: A simple tool for evaluation of adherence to therapy in patients with inflammatory bowel disease

• Published in: United European gastroenterology journal 2017-10, Vol.5 (6), p.880-886
• Main Authors: Engel, T, Ungar, B, Ben-Haim, G, Levhar, N, Eliakim, R, Ben-Horin, S
• Format: Article
• Language: English
• Subjects: adherence; compliance; Crohn’s disease; Inflammatory bowel disease; Original; ulcerative colitis
• ISSN: 2050-6406; 2050-6414
• DOI: 10.1177/2050640616687838

Background Non-adherence to medication in patients with inflammatory bowel disease (IBD) is a challenging problem which is often overlooked or under-estimated by the physician or denied by the patient. We aimed to examine if re-phrasing the wording of the question used by the physician could help in revealing more patients who are non-adherent, and for whom appropriate counseling may be instituted. Methods A cross-sectional questionnaire-based study of IBD patients treated in a tertiary center was conducted. Patients received a questionnaire detailing their treatments and disease course, as well as their perceptions about disease. Two forms of questions about adherence were deliberately placed in two separate parts of the questionnaire: One was ‘are you taking your medications regularly as prescribed?’ (Standard question), and the second, more emphatic question, was ‘how often does it happen that you miss a drug dosing?’ (Re-phrased question). The rate of non-adherence disclosed by each of these questions was compared. Sensitivity, specificity and predicative values were computed for each question against the conventional definition of non-adherence as taking of less than 80% of prescribed medication doses disclosed by any of the methods. Predictors of non-compliance and of denying non-compliance were also explored. Results Overall, 165 patients were included (49% female, mean age 33.7 ± 12.7 SD, median age 30 years, 29.6% with ulcerative colitis, 62.4% with Crohn’s disease). Upon questioning, 50 (30.3%) of the patients admitted to non-adherence in the last month when asked by the emphatic re-phrased question format, compared with only 10 patients (6%) reporting non-adherence when asked directly by the standard question (OR 7.4, 95%CI 3.6–15.2, p