Research Article
The Frequency of Clinic Visits Was Not Associated
with Medication Adherence or Outcome in Children with
Inflammatory Bowel Diseases
Cheryl Kluthe,
1
Jenkin Tsui,
2
Donald Spady,
3
Matthew Carroll,
1
Eytan Wine ,
1
and Hien Quoc Huynh
1
1
Edmonton Pediatric IBD Clinic (EPIC), Edmonton, AB, Canada
2
University of Edinburgh, Edinburgh, UK
3
Division of Pediatric GI Nutrition, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
Correspondence should be addressed to Hien Quoc Huynh; hien.huynh@ualberta.ca
Received 29 August 2017; Accepted 17 January 2018; Published 25 February 2018
Academic Editor: Fabio Grizzi
Copyright © 2018 Cheryl Kluthe et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Medication nonadherence is a challenge in pediatric patients with infammatory bowel diseases (IBD). Poor adherence
can result in disease fare-ups, disease complicationstherapy escalation, and the need for corticosteroids. Te aim was to determine
if clinic visit frequency was associated with treatment adherence. Methods. A retrospective chart review of patients attending the
Edmonton Pediatric IBD Clinic (EPIC) at the Stollery Children’s Hospital from January 2012 to December 2013 was completed.
Correlations were made between frequency of clinic visit, percentage of prescriptions flled, percentage of requisitioned blood work
completed, rural or urban residence, and steroid-free remission status of patients for the 6 months afer the chart review. Results. 127
patients were reviewed with 82 patients diagnosed with Crohn’s disease (CD) and 46 with ulcerative colitis (UC) which included
one IBD-Unclassifed. Mean age at diagnosis is 9.17 years and median duration of follow-up is 3.2 years. Almost all patients on
infiximab infusions received them “within window.” Immunomodulator median adherence rate was 88%. 5-ASA adherence was
82%. A median of 67% of patients had blood work completed as requested. Clinic visit frequency was not associated with adherence
to blood work or to medications. Duration of disease was the only independent factor found to be associated with a reduction in
blood work and immunomodulator adherence (“OR 0.86 and 95% CI: 0.74–0.99” and “OR 0.82 and 95% CI: 0.71–0.97”) per year,
respectively. Patients who remained corticosteroid-free in the 6 months afer the 2 years’ adherence review had an overall median
medication adherence rate of 86% compared to only 53% for those who relapsed and required corticosteroids ( = 0.01). Conclusion.
Clinic visit frequency was not associated with patient adherence to medications or blood work. However, disease duration was found
to be associated with medication adherence. Adherent patients were more likely to remain in steroid-free remission.
1. Introduction
1.1. Background. Infammatory bowel disease (IBD) is a
chronic condition that leads to infammation in the digestive
tract. It is characterized by periods of disease activity and
periods of disease remission [1]. Canada has one of the
highest incidence rates of Crohn’s disease (CD) and ulcerative
colitis (UC) in the world: 13.4 and 11.8 cases over 100,000
persons for CD and UC [2]. Furthermore, the incidence
of IBD in children under 10 years of age is increasing [3].
Currently, there is no cure for IBD, leading to the need for
chronic treatment. Medication nonadherence is a challenging
issue for patients with a chronic disease, including pediatric
patients with IBD. Pediatric IBD is unique in that both the
patients and the parents have a shared responsibility for
administering medications [4]. Poor adherence can result in
disease fare-ups, disease complications, therapy escalation,
and need for corticosteroids. Previous studies indicate that
nonadherent patients are 5.5 times more likely to experi-
ence a fare compared to individuals who are adherent [4].
Nonadherence rates range from 50 to 80% [4], with patients
overestimating their oral medication intake rate by 23% [5].
Hindawi
Canadian Journal of Gastroenterology and Hepatology
Volume 2018, Article ID 4687041, 10 pages
https://doi.org/10.1155/2018/4687041