S804 Identifying Targets for Improving Inflammatory Bowel Disease Medication Adherence

Abstract

Introduction: Medication adherence is challenging for patients, leading to suboptimal inflammatory bowel disease (IBD) care despite the availability of effective treatments. Patients’ self-efficacy—their ability to cope with specific stresses or challenges in disease management —is predictive of self-management behavior, such as medication adherence, for many chronic illnesses. Patient activation—the degree to which a patient is ready, willing, and able to engage in behavior change—is also critical to improving self-management, and has been associated with better IBD control. Our objective was to understand the relationship between self-efficacy, patient activation, and medication adherence to tailor improvement efforts. Methods: A convenience sample of patients with IBD were recruited to complete a survey composed of the IBD Self-Efficacy Scale, the Patient Activation Measure, and the Morisky Medication Adherence Scale. Using multivariable linear regression, we examined the relationship between three concepts of self-management: self-efficacy, patient activation, and medication adherence. We adjusted a priori for age, IBD type, disease activity using validated patient reported outcomes, and IBD severity defined by current or prior use of biologics or immunomodulators. Results: We enrolled 87 patients with IBD who were seen by a gastroenterologist at a single medical center. A majority were white (89.7%), female (63.1%), younger than 60 years (57.5%), with ulcerative colitis (41.9%) or Crohn’s disease (48.8%), and moderate-to-severe disease (70.1%). Patient activation positively correlated with self-efficacy (r=0.22; p=0.039), and self-efficacy positively correlated with medication adherence (r=0.40; p< 0.001). However, patient activation did not correlate with medication adherence (p=NS), suggesting the relationship between self-efficacy and medication adherence was not mediated through patient activation (Figure 1). In multivariable analyses, higher medication adherence was associated with a higher self-efficacy, moderate-to-severe disease, and Crohn’s disease, and higher patient activation was associated with higher self-efficacy (Table 1). Conclusion: Self-efficacy and patient activation are distinct concepts. Self-efficacy is associated with both medication adherence and patient activation suggesting its important role in IBD care. Self-efficacy may be an important target in improving IBD self-management, but needs to be further elucidated in larger studies.Figure 1.: Cumulative Incidence Curves of Time to Adverse Outcomes within one-year follow-up.Table 1.: Crude Odds Ratio and Adjusted Differences for Primary and Secondary Outcomes in Patients with Crohn’s disease Who Underwent Elective Bowel Resection with vs without Severe Protein Calorie Malnutrition