Building trust between clinicians and patients and tailoring approaches to patients’ personal views of their IBD may be key to improving medication adherence, a qualitative study has found.
Unearthed through focus group discussions, the results highlight the importance ensuring patients accept their IBD diagnosis and understand how prescribed medications function to manage their disease, according to the researchers.
Comprising Crohn’s and ulcerative colitis patients in Otago, New Zealand, the focus group participants all had a strong understanding of the importance of medicine adherence to their IBD management, which they saw as helping to maintain their health and wellbeing and prevent disease outcomes.
Despite this, most admitted to having either forgotten or deliberately decided against taking their medication at least once, the researchers reported in Exploratory Research in Clinical and Social Pharmacy (link here).
Most often, this was due to a disruption in routine, such as a change in working hours or holiday, but travel – particularly overseas – was another frequently cited issue.
Other common barriers to adherence included side effects, complex medication regimens, unpleasant modes of administration (including large pill size) and the cost of obtaining new prescriptions via a GP or specialist, the researchers said.
Interestingly, disease symptoms could be another significant factor, with both negative and positive impacts on adherence, they added.
“The discussants noted that disease symptoms such as “brain fog” associated with fatigue made forgetting to adhere more likely,” they wrote.
“Whereas, the subtle appearance of symptoms, e.g. tiredness, served as a reminder to take upcoming medication doses; thus presenting the impact of symptoms on medication adherence as bidirectional.”
Nevertheless, feedback from focus group participants demonstrated most obstacles could be overcome with appropriate patient education, according to the authors.
“Moreover, as a patient expressed, sometimes (good) medication adherence can provide psychological comfort that disease progression is not always the result of poor adherence and, hence, is unavoidable,” they wrote.
“This reinforced the discussants’ view of medication adherence as a duty to follow the medication regimen.”
“Central to this was trusting their prescribing [healthcare professional].”
Communication here was key, as each patient’s perspective and understanding of their disease was unique and evolved over time, the researchers suggested.
Another interesting finding was that while all patients adopted a medication-taking routine, the key to successful adherence was “proactivity”.
This could include obtaining a prescription through to remembering to take them or, when travelling, pre-stocking up on medications, using cooler bags when in transit, ensuring hotel rooms had fridges, and making provision for customs checks and proper medicine storage, the researchers said.
“There was broad consensus that medication adherence required conscious effort by the patient,” they added.
The authors concluded: “Medication adherence in IBD is complex with patients often taking several medicines in varying doses/frequencies, administered via different routes (oral, intravenous, suppository, subcutaneous) and needing different storage environments.”
“It is, however, essential as uncontrolled IBD can lead to serious surgeries including gut resection besides considerably impacting patients’ wellbeing.”