Assessing Oral Medication Adherence and Identifying Predictors of Low Adherence in Chinese Inflammatory Bowel Disease Patients

Figures & data

Table 1 Modified MMAS-8 for IBD Patients and Frequencies for MMAS-8 Scale

MMAS Questions	Scoring	5-ASA	Azathioprine
1. Do you sometimes forget to take your IBD medication?	1 No; 0 Yes	55%	44%
2. People sometimes miss taking their medications for reasons other than forgetting. Thinking over the past 2 weeks, was there a time when you did not take your medication?	1 No; 0 Yes	11%	27%
3. Have you ever cut back or stopped taking your medication without telling your doctor because you felt worse when you took it?	1 No; 0 Yes	5%	12%
4. When you travel or leave home, do you sometimes forget to bring along your IBD medication?	1 No; 0 Yes	33%	21%
5. Did you take your IBD medicine yesterday or at the last scheduled dose?	1 No; 0 Yes	16%	19%
6. When you feel like your IBD symptoms are under control, do you sometimes stop taking your medication?	1 No; 0 Yes	25%	13%
7. Taking medication regularly is a real inconvenience for some people. Do you ever feel hassled about sticking to your IBD treatment plan?	1 No; 0 Yes	9%	4%
8. How often do you have difficulty remembering to take all your IBD medications?
Never/rarely	1		43%
Once in a while	0.75		31%
Sometimes	0.5		24%
Usually	0.25		2%
All the time	0		0%

Notes: Use of the MMAS is protected by US copyright laws. Permission for use is required. Licensure agreement is available from Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, California 90095, USA.

Table 2 Patient Characteristics (n=106)

Sex, n (%)
Male	73	69%
Female	33	31%
Disease, n (%)
UC	48	45%
CD	58	55%
Age, median (range)	33	19–52
Age at diagnosis		29±8
Duration of disease (range)	4	3–7
Smoking, n (%)
Never smoked	85	80%
Currently smoking	9	9%
Ex-smoker	12	11%
Disease localization, n (%)
Colon	76	72%
Small intestine	39	37%
Both colon and small intestine	13	12%
Unknown	4	4%
Abdominal surgery in the past, n (%)
NO	72	68%
YES	34	32%
Marital status, n (%)
Married	68	64%
Non-Married	35	33%
Divorced	3	3%
Highest level of education completed, n (%)
Illiterate	0	0%
Primary school certificate	3	3%
Middle school certificate	9	9%
High school/Secondary vocational school	16	15%
Three-year college diploma	24	23%
Bachelor’s level	43	41%
Master’s and Doctorate’s level	11	10%
Self-reported monthly income, n (%)
Under 650€	26	25%
650–1300€	28	26%
1300–2600€	32	30%
Above 2600€	20	19%
Disease activity, n (%)
Active	25	24%
Inactive	81	76%
Medication, n (%)
Oral 5-aminosalicylic acid	54	51%
5-ASA enemas and suppositories	26	24%
Immunomodulator	54	51%
Infliximab	8	8%
Steroids	10	9%
Thalidomide	11	10%
Enteral nutrition	27	26%
IBD treatment
Monotherapy	62	58%
Combination	44	42%
Dosing schedule
Once-a -day	42	40%
Twice-a-day	24	23%
Three-times-a-day	27	25%
Four-times-a day	13	12%
MMAS-8 score, median (range)	6.8	5.4–7.8
Low adherer, n (%)	38	36%
Medium adherer, n (%)	47	44%
High adherer, n (%)	21	20%

Table 3 Predictive Factors for Adherence According to MMAS (Univariate Analysis)

	Low Adherence	High Adherence	P-value
Patients	38(36%)	68(64%)
Gender			0.609
Male	25(34%)	48(66%)
Female	13(39%)	20(61%)
Current age (years)	33(29–36)	34(29–39)	0.42
Age at diagnosis	28±7	29±8	0.62
Duration of disease (years)	4(3–6)	4(3–7)	0.53
Currently smoking, n (%)			0.869
NO	35(36%)	62(64%)
YES	3(33%)	6(67%)
Abdominal surgery in the past, n (%)			0.34
NO	28(39%)	44(61%)
YES	10(29%)	24(71%)
Disease localization, n (%)
Colon			0.366
NO	12(40%)	18(60%)
YES	26(34%)	50(66%)
Small intestine			0.145
NO	21(31%)	46(69%)
YES	17(44%)	22(56%)
Both colon and small intestine			0.408
NO	32(34%)	61(66%)
YES	6(46%)	7(54%)
Marital status, n (%)			0.561
Married	23(34%)	45(66%)
Non-Married	15(39%)	23(61%)
Highest level of education completed, n (%)			0.477
No	18(35%)	34(65%)
YES	20(37%)	34(63%)
Self-reported monthly income, n (%)			0.841
Under 5000 ¥/5000–10,000¥	20(37%)	34(63%)
10,000–20,000¥/above 20,000¥	18(35%)	34(65%)
Medication use at 3 mo of follow-up, n (%)
5-ASA use			0.818
NO	17(35%)	32(65%)
YES	21(37%)	36(63%)
Thiopurines			0.582
NO	20(38%)	32(62%)
YES	18(33%)	36(67%)
IBD treatment			0.751
Monotherapy	23(37%)	39(63%)
Combination	15(34%)	29(66%)
Daily dose IBD medication			0.394
One	13(31%)	29(69%)
More than one	25(39%)	39(61%)
MPR			0.0001
Low (<0.8)	31(91%)	3(9%)
High (≥0.8)	7(10%)	65(90%)

Table 4 Predictive Factors for Adherence According to MPR (Univariate Analysis)

	Non-Adherence	Adherence	P value
Patients	34(32%)	72(68%)
Gender			0.489
Male	24(33%)	49(67%)
Female	10(30%)	23(70%)
Current age (years)	34(29–37)	33(29–39)	0.596
Age at diagnosis	28±7	29±8	0.64
Duration of disease (years)	4(2–6)	4(3–7)	0.92
Currently Smoking, n (%)			0.598
NO	31(32%)	66(68%)
YES	3(33%)	6(67%)
Abdominal surgery in the past, n (%)			0.268
NO	25(35%)	47(65%)
YES	9(26%)	25(74%)
Disease localization, n (%)
Colon			0.192
NO	12(40%)	18(60%)
YES	22(29%)	54(71%)
Small intestine			0.016
NO	16(24%)	51(76%)
YES	18(46%)	21(54%)
Both colon and small intestine			0.197
NO	28(30%)	65(70%)
YES	6(46%)	7(54%)
Marital status, n (%)			0.443
Married	21(30%)	47(70%)
Non-Married	13(34%)	25(66%)
Highest level of education completed, n (%)			0.182
No	14(27%)	38(73%)
YES	20(37%)	34(63%)
Self-reported monthly income, n (%)			0.366
Under 5000 ¥/5000–10,000¥	16(30%)	38(70%)
10,000–20,000¥/above 20,000¥	18(35%)	34(65%)
Medication use, n (%)
5-ASA use			0.371
NO	17(35%)	31(65%)
YES	17(30%)	40(70%)
Thiopurines			0.47
NO	16(31%)	36(69%)
YES	18(33%)	36(67%)
IBD treatment			0.4
Monotherapy	21(34%)	41(66%)
Combination	13(30%)	31(70%)
Daily dose IBD medication			0.507
One	13(31%)	29(69%)
More than one	21(33%)	43(67%)
MMAS score			0.0001
Low (<6)	31(82%)	7(18%)
High (6–8)	3(4%)	65(96%)

Table 5 Multivariate Analysis in IBD Patients

	Multivariate Analysis
	Odds Ratio (95% CI)	P-value
Current age	1.08 [1.02–1.13]	0.0015
Age at onset	1.08 [1.01–1.14]	0.02
Previous abdominal surgery	3.18 [2.09–4.27]	0.04
Small intestine lesion	0.09 [0.01–0.17]	0.006

Figure 1 Correlation between MMAS-8 score and pharmacy refill behavior for 5-ASA.

Figure 2 Correlation between MMAS-8 unintentional score and pharmacy refill behavior for 5-ASA.