Alternative Medicine Use and Medication Adherence in IBD
Alternative Medicine Use and Medication Adherence in IBD
Background Complementary and alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients is common. We characterised CAM utilisation and assessed its impact on medical adherence in the IBD population.
Aim To characterise CAM utilisation and assess its impact on medical adherence in the IBD population.
Methods Inflammatory bowel disease patients recruited from an out-patient clinic at a tertiary centre were asked to complete a questionnaire on CAM utilisation, conventional IBD therapy, demographics and communication with their gastroenterologist. Adherence was measured using the self-reported Morisky scale. Demographics, clinical characteristics and self-reported adherence among CAM and non-CAM users were compared.
Results We recruited prospectively 380 IBD subjects (57% Crohn's disease; 35% ulcerative colitis, and 8% indeterminate colitis). The prevalence of CAM use was 56% and did not significantly vary by type of IBD. The most common reason cited for using CAM was ineffectiveness of conventional IBD therapy (40%). The most popular form of CAM was probiotics (53%). CAM users were younger than non-CAM users at diagnosis (21.2 vs. 26.2, P < 0.0001) and more likely than non-CAM users to have a University-level education or higher (75% vs. 62%P = 0.006). There was no overall difference in adherence between CAM and non-CAM users (Morisky score: 1.0 vs. 0.9, P = 0.26).
Conclusions The use of complementary and alternative medicine is widely prevalent among IBD patients, and is more frequent among those with experience of adverse effects of conventional medications. From this cross-sectional analysis, complementary and alternative medicine use does not appear to be associated with reduced overall adherence to medical therapy.
The use of complementary and alternative medicine (CAM) among patients with inflammatory bowel disease (IBD) is increasing. Currently, nearly half of IBD patients report having used CAM at some point during their illness. This observation has been fairly consistent throughout various populations across North American and Europe. CAM use has been associated with a variety of demographic features including younger age, female gender and higher educational level. Reasons for the high prevalence of CAM use in IBD include lack of response to conventional therapy, perceived favourable safety profile, and a sense of greater control over their disease.
Many patients who are interested in alternative therapies report minimal discussion with their gastroenterologist before using CAM. This lack of communication has the potential to lead to important drug interactions and toxicities. Furthermore, CAM use, especially if undisclosed, may erode trust and affect the therapeutic relationship between physician and patient.
There are very few reports of the effect of CAM use on adherence to conventional therapy. In other chronic diseases such as hypertension, CAM use was associated with a 25% lower adherence to medication. In our present study, we report a cross-sectional analysis that characterises CAM utilisation and explores any associations with medical adherence in IBD.
Abstract and Introduction
Abstract
Background Complementary and alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients is common. We characterised CAM utilisation and assessed its impact on medical adherence in the IBD population.
Aim To characterise CAM utilisation and assess its impact on medical adherence in the IBD population.
Methods Inflammatory bowel disease patients recruited from an out-patient clinic at a tertiary centre were asked to complete a questionnaire on CAM utilisation, conventional IBD therapy, demographics and communication with their gastroenterologist. Adherence was measured using the self-reported Morisky scale. Demographics, clinical characteristics and self-reported adherence among CAM and non-CAM users were compared.
Results We recruited prospectively 380 IBD subjects (57% Crohn's disease; 35% ulcerative colitis, and 8% indeterminate colitis). The prevalence of CAM use was 56% and did not significantly vary by type of IBD. The most common reason cited for using CAM was ineffectiveness of conventional IBD therapy (40%). The most popular form of CAM was probiotics (53%). CAM users were younger than non-CAM users at diagnosis (21.2 vs. 26.2, P < 0.0001) and more likely than non-CAM users to have a University-level education or higher (75% vs. 62%P = 0.006). There was no overall difference in adherence between CAM and non-CAM users (Morisky score: 1.0 vs. 0.9, P = 0.26).
Conclusions The use of complementary and alternative medicine is widely prevalent among IBD patients, and is more frequent among those with experience of adverse effects of conventional medications. From this cross-sectional analysis, complementary and alternative medicine use does not appear to be associated with reduced overall adherence to medical therapy.
Introduction
The use of complementary and alternative medicine (CAM) among patients with inflammatory bowel disease (IBD) is increasing. Currently, nearly half of IBD patients report having used CAM at some point during their illness. This observation has been fairly consistent throughout various populations across North American and Europe. CAM use has been associated with a variety of demographic features including younger age, female gender and higher educational level. Reasons for the high prevalence of CAM use in IBD include lack of response to conventional therapy, perceived favourable safety profile, and a sense of greater control over their disease.
Many patients who are interested in alternative therapies report minimal discussion with their gastroenterologist before using CAM. This lack of communication has the potential to lead to important drug interactions and toxicities. Furthermore, CAM use, especially if undisclosed, may erode trust and affect the therapeutic relationship between physician and patient.
There are very few reports of the effect of CAM use on adherence to conventional therapy. In other chronic diseases such as hypertension, CAM use was associated with a 25% lower adherence to medication. In our present study, we report a cross-sectional analysis that characterises CAM utilisation and explores any associations with medical adherence in IBD.
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