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P-223 Carelessness with Medication Usage Reduced by a Specialized Pediatric Inflammatory Bowel Disease Clinic

Background:Inflammatory Bowel Disease (IBD) is a chronic, autoimmune disease of the digestive tract that affects approximately 71 out of 100,000 youth below the age of 20 years in the USA.1 IBD has an intermittent and variable course and is often treated with a complex regimen of multiple medications that makes consistent adherence very challenging.2 Adherence to medications is important to maintain remission, decrease disease inflammation, and maintain adequate nutrition.3 However, many patients and primary caregivers have limited knowledge about their condition and how to manage their disease. The aim of this study was to determine whether implementing a specialized IBD clinic for pediatric patients with IBD improved knowledge about their disease, improved confidence in managing their disease, and improved medication adherence compared to patients followed in a general pediatric gastroenterology (GI) clinic. The IBD clinic featured longer appointment times as well as disease and medication education by an IBD-focused nurse practitioner or pediatric gastroenterologist. Education consisted of verbal one-on-one discussion as well as provision of written materials. Effects of age, gender, and education level of caregivers on adherence were also examined. Methods:A total of 75 patients with IBD ages 5 to 19 participated in the study. The study was underpowered secondary to changes in referral patterns from when study was initiated. After obtaining informed consent, caregivers were asked to complete a written eleven question survey to assess their knowledge about their patient's disease. Questions pertained to their specific disease location, confidence level in managing their disease, number of ER visits, and medication adherence. Knowledge of specific disease locations was evaluated for accuracy by comparing the participant's response to their medical record. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-4). Statistical analyses for proportions were performed using the chi-square test or Fisher's exact test and for means the 2-group t-test. Statistical tests were 2 sided, with a P-value <0.05 indicating statistical significance. Analyses were performed using SAS. Results:Patient demographics and diagnosis were similar to overall patient population followed at our IBD center. In regards to adherence, patients attending the specialized pediatric IBD clinic reported being less careless about taking their medications compared to patients followed in a general pediatric GI clinic (71% versus 29%, respectively; P = 0.006). Caregiver involvement in medication dosing decreased the likelihood that the patient reportedly stopped taking their medication if they felt better compared to exclusive patient responsibility (87% versus 13%, respectively; P = 0.018). Overall medication adherence and disease knowledge were not significantly different for patients attending the specialized IBD clinic. Results based on gender, age, race, diagnosis, and parental education level were not statistically significant. Conclusions:Implementation of a specialized pediatric IBD clinic and parental involvement in taking medications may help to reduce some aspects of medication nonadherence in pediatric patients with IBD. Further studies and improvement efforts are needed to improve overall adherence and patient/caregiver education.