P072 Adherence to medical treatment in inflammatory bowel disease in a referral center in Bahia, Brazil
Authors: Laíla Andrade , Fernanda Oliveira , Victor Mariano , Fernanda Pereira , Monique Santos , Claudia dos Santos , Andréa Pimentel , Jaciane Fontes , Neogélia Almeida , Valdiana Surlo , Maria Fortes Flora , Bruno Silva , Genoile Santana 
Published: July 2019

BACKGROUND:
In the context of inflammatory bowel disease (IBD), the non-adherence to treatment may negatively affect the patient's clinical evolution, making them more vulnerable to relapses and exacerbations. Despite more than 5 decades of research on the subject, the problem persists in the health system. In order to understand the low adherence it is important to recognize the central role of the patient in this context, without leaving aside the determinants related to treatment and health services.

METHODS:
It is an observational and cross-sectional study, carried out from June/2017 to July/2018, with questionnaire application and review of medical records in a referral center in IBD in Salvador, Bahia. The study population included patients with IBD diagnosed according to the criteria of European Crohn's2 and Colitis3 Organization and the Morisky-Green4 test was applied to evaluate drug adherence. All statistical analyzes were performed by the statistical software package SPSS version 21.0 for Windows. Chi-square test was used to evaluate association between categorical variables and treatment adherence. For statistical significance, P-value of less than 0.05 was admitted.

RESULTS:
A total of 302 patients were included, 62.9% female and the mean age was 45.8 years (SD ± 15.05). Of the total sample, 61.6% had ulcerative colitis (UC). Non-adherence was present in 72.5% of the sample. According to disease activity, it was demonstrated that among the 92 patients with Crohn's disease (CD) in remission, 67.4% presented non-adherence; among the 15 individuals in mild to moderate activity, 66.7% were non-adherers and among 11 patients with moderate to severe activity, 72.7% behaved with non-adherence. For UC, of the 142 patients in remission, 75.3% were non-adherers; for 33 patients with mild to moderate activity, 72.7% presented nonadherence and among the 10 patients with severe colitis, 90.0% behaved with nonadherence. Among the 65 patients with side effects, 26.2% were adherers patients, while 73.8% were non-adherers; among the 188 individuals who did not report side effects after the introduction of the drugs for the IBD, 30.9% were adherers patients and 69.1% presented non-adherence. Among the 134 patients in polypharmacy, 69.4% were non-adherers; while those using only IBD therapy, 74.5% behaved with nonadherence. There was no significant statistical difference when comparing non-adherent patients with disease activity in IBD (P = 0.832), side effects after IBD-drug introduction (P = 0.475) and polypharmacy (P = 0.327).

CONCLUSION(S):
A high frequency of non-adherence was observed in the sample studied, both in Crohn's disease and in ulcerative colitis. The presence of polypharmacy and side effects did not influence in the medication adherence. Patients with more severe inflammatory activity had a lower adherence to therapy in the sample studied, but there was no statistically significant difference when comparing such variables. The findings are similar to those described in other centers.