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CONSEQUENCES OF INTENTIONAL AND UNINTENTIONAL NONADHERENCE IN INFLAMMATORY BOWEL DISEASE PATIENTS
DDW ePoster Library. Cho S. 05/21/22; 354310; Sa1553
Dr. Su Min Cho
Dr. Su Min Cho
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Number: Sa1553
CONSEQUENCES OF INTENTIONAL AND UNINTENTIONAL NONADHERENCE IN INFLAMMATORY BOWEL DISEASE PATIENTS

Society: AGA
Track: Inflammatory Bowel Diseases

Author(s): Su Min Cho1, Rajdeepsingh Waghela1, Adam Saleh3, Bincy P Abraham1, 2

Institution(s): 1. Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, United States. 2. Weill Cornell Medicine, New York, NY, United States. 3. ENMED, Houston, TX, United States.

Introduction: The management of inflammatory bowel disease (IBD), despite its many advances over the years, can be greatly limited by patient nonadherence. Nonadherence can be divided into two broad categories, with intentional nonadherence being primarily driven by the patients' free will while unintentional nonadherence being primarily driven by factors outside patients' control. This study explores the pattern of nonadherence and the impact that specific types of nonadherence can have on IBD complications.
Methods: We performed a retrospective analysis of patients from a single-center IBD program from the year 2010 to 2021 who were found to have medical record documentation of nonadherence to their IBD regimen, whether it be for medications, clinic visits, lab evaluations, and/or endoscopic evaluations. We found 58 unique patients to be nonadherent, with a total nonadherence count of 78. Basic demographic data was obtained for the unique patients. The primary analysis was focused on the intentionality of these patients' nonadherence (intentional vs unintentional). Additional data points included type of nonadherence (medications, clinic visits, lab draws, endoscopies), reason for nonadherence, as well as complications (flares, need for escalation of therapy, need for surgery, infection, etc.)
Result: At our center, more females (62.1%) than males (37.9%) were nonadherent to their IBD regimen. Of total nonadherence occurrences, 66.7% were intentional and 33.3% were unintentional, and there was no statistically significant association between intentionality and sex. A sheer majority of unintentional adherence was related to insurance and cost. The majority of nonadherent behaviors were largely seen with medications (78%), and this was especially with unintentional nonadherence (96.15%). When comparing between intentional and unintentional nonadherence patients, there was no statistical difference in subsequent flare development, need for escalation of therapy, need for systemic steroids, need for hospitalization, development of EIM, and development of cancer. However, there was a statistical difference (p = 0.029) for a higher need for surgery in unintentional nonadherence.
Discussion: Insurance and cost issues are major sources of unintentional nonadherence despite the majority of these patients having insurance, a frustrating reality for both patients and physicians. Most IBD complications appear to occur similarly between intentional and unintentional nonadherence, with the exception being the higher need for surgical intervention in unintentional nonadherence. This highlights the need to maintain active coverage of IBD management due to the complications and higher expenses that could likely be avoided in unintentional nonadherence.
Number: Sa1553
CONSEQUENCES OF INTENTIONAL AND UNINTENTIONAL NONADHERENCE IN INFLAMMATORY BOWEL DISEASE PATIENTS

Society: AGA
Track: Inflammatory Bowel Diseases

Author(s): Su Min Cho1, Rajdeepsingh Waghela1, Adam Saleh3, Bincy P Abraham1, 2

Institution(s): 1. Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, United States. 2. Weill Cornell Medicine, New York, NY, United States. 3. ENMED, Houston, TX, United States.

Introduction: The management of inflammatory bowel disease (IBD), despite its many advances over the years, can be greatly limited by patient nonadherence. Nonadherence can be divided into two broad categories, with intentional nonadherence being primarily driven by the patients' free will while unintentional nonadherence being primarily driven by factors outside patients' control. This study explores the pattern of nonadherence and the impact that specific types of nonadherence can have on IBD complications.
Methods: We performed a retrospective analysis of patients from a single-center IBD program from the year 2010 to 2021 who were found to have medical record documentation of nonadherence to their IBD regimen, whether it be for medications, clinic visits, lab evaluations, and/or endoscopic evaluations. We found 58 unique patients to be nonadherent, with a total nonadherence count of 78. Basic demographic data was obtained for the unique patients. The primary analysis was focused on the intentionality of these patients' nonadherence (intentional vs unintentional). Additional data points included type of nonadherence (medications, clinic visits, lab draws, endoscopies), reason for nonadherence, as well as complications (flares, need for escalation of therapy, need for surgery, infection, etc.)
Result: At our center, more females (62.1%) than males (37.9%) were nonadherent to their IBD regimen. Of total nonadherence occurrences, 66.7% were intentional and 33.3% were unintentional, and there was no statistically significant association between intentionality and sex. A sheer majority of unintentional adherence was related to insurance and cost. The majority of nonadherent behaviors were largely seen with medications (78%), and this was especially with unintentional nonadherence (96.15%). When comparing between intentional and unintentional nonadherence patients, there was no statistical difference in subsequent flare development, need for escalation of therapy, need for systemic steroids, need for hospitalization, development of EIM, and development of cancer. However, there was a statistical difference (p = 0.029) for a higher need for surgery in unintentional nonadherence.
Discussion: Insurance and cost issues are major sources of unintentional nonadherence despite the majority of these patients having insurance, a frustrating reality for both patients and physicians. Most IBD complications appear to occur similarly between intentional and unintentional nonadherence, with the exception being the higher need for surgical intervention in unintentional nonadherence. This highlights the need to maintain active coverage of IBD management due to the complications and higher expenses that could likely be avoided in unintentional nonadherence.

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