Can Medication Adherence Be Improved in Patients With IBD?

Sunanda V. Kane, MD, MSPH

Disclosures

September 12, 2011

Question

Many patients with Crohn disease and ulcerative colitis skip their maintenance medications when they are asymptomatic. How can they be convinced to keep taking their medications?

Response from Sunanda V. Kane, MD, MSPH
Professor of Medicine, Mayo Medical College; Consultant, Mayo Clinic, Rochester, Minnesota

It is often difficult to persuade patients to continue taking their medications when they are feeling well. I use several tactics with my patients, which are based on observation and evidence. First, I explain that the reason they are feeling well is because they were taking medications, and that because they have a condition that cannot be cured, the medications that resulted in feeling well will continue to keep them well. The example that I use is diabetes. If patients with diabetes have good glucose control on insulin, we don't tell them to stop the insulin because their glucose is normal.

In ulcerative colitis, we can tell patients that remission and having a healed colon are associated with a lower risk for recurrence -- and down the road, a lower risk for colon cancer. Disease remission is also associated with lower healthcare costs and reduced incidence of disease complications, such as hospitalizations and colectomy.

In Crohn disease, prolonged remission is associated with a lower risk for complications, hospitalizations, and surgery as well as lower healthcare costs, not only to patients' insurance companies but out-of-pocket costs as well. It is cheaper to continue to take a medication than to stop it; experience a flare; and end up in the hospital, emergency department, or operating room. Recent evidence demonstrates that patients who have been well for 5 years and then stop their medications are 50% more likely to experience a flare within a year compared with those who continue their maintenance medications.

I have my patients think about their maintenance medications as preventive rather than punitive; these agents are preventing disease and maintaining health just like a vitamin would. Healthcare providers should elicit any information that may lead to nonadherence, such as adverse effects of the medications. Financial issues might also lead patients to stop their therapy. Workarounds such as switching agents or getting drug company assistance for those who can't pay can provide solutions to these difficulties.

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