The Association between the Therapeutic Agent and the Compliance of the Patients with Inflammatory Bowel Diseases

Yun-Seong Kang; So Young Kim; Min Ho Jo; Hyoun Woo Kang; Jun Kyu Lee; Yun Jeong Lim; Moon Soo Koh; Jin Ho Lee; Chang Hun Yang; Jae Hak Kim

doi:10.4166/kjg.2013.61.6.313

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Kang, Kim, Jo, Kang, Lee, Lim, Koh, Lee, Yang, and Kim: The Association between the Therapeutic Agent and the Compliance of the Patients with Inflammatory Bowel Diseases

Original Article

Korean J Gastroenterol 2013;61(6):313-318.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.6.313

The Association between the Therapeutic Agent and the Compliance of the Patients with Inflammatory Bowel Diseases

Yun-Seong Kang, So Young Kim, Min Ho Jo, Hyoun Woo Kang, Jun Kyu Lee, Yun Jeong Lim, Moon Soo Koh, Jin Ho Lee, Chang Hun Yang, Jae Hak Kim

Department of Internal Medicine, Dongguk University Ilsan Hospital, the Graduate School, Dongguk University, Goyang, Korea

Correspondence to: Jae Hak Kim, Department of Internal Medicine, Dongguk University Ilsan Hospital, 27 Donggung-ro, Ilsandong-gu, Goyang 410-773, Korea. Tel: +82-31-961-7127, Fax: +82-31-961-7141, E-mail: kimjaehak@dumc.or.kr

Received 10 March 20138 May 2013 Accepted 8 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Adherence of the patients with inflammatory bowel diseases is important to maintain the remission. However, the patients do not always keep their appointments for treatment. The aim of this study was to investigate the clinical factors associated with adherence of patients in terms of appointment keeping.

Methods

A total of 73 subjects were retrospectively investigated from September 2005 to January 2012 at Dongguk University Ilsan Hospital (Goyang, Korea). We reviewed medical records including the age, sex, residence, medications, the disease activity, and the rate of keeping the date. A punctual visit was defined as outpatient visit on the scheduled date ±7 days. Punctual patients for the visit were defined as their punctual visit rates exceed 90%.

Results

Male to female ratio was 2.4:1. Mean age was 41.5±15.4 years (range, 20 to 78 years). Ulcerative colitis was 53 cases (72.6%) and Crohn's disease was 20 cases (27.4%). Mean duration of disease was 42.0±41.6 months (range, 4 to 226 months). Mean puntual visit rate was 86.7±16.0% (range, 27 to 100). Thirty-eight patients (52.1%) were punctual patients for the visit. Azathioprine/6-mercaptopurine treatment was associated with punctual patients for the visit (odd ratio, 3.19; 95% confidence interval, 1.12 to 9.09; p=0.03). However, other clinical factors did not influence the punctual visit rates.

Conclusions

Our study demonstrated that the use of azathioprine/6-mercaptopurine was associated with keeping the appointment for meeting the doctor. Further prospective study would be necessary.

Keywords: Inflammatory bowel diseases, Compliance, Azathioprine, 6-Mercaptopurine

References

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Fig. 1.

Comparison of punctual visit rates between AZA/6-MP group and non-AZA/6-MP group. AZA, azathioprine; 6-MP, 6-mercaptopurine.

Table 1.

Baseline Characteristics of the Study Population (n=73)

Variable	Data
Age (yr)	41.5±15.4 (20–78)
Sex
Male	49 (67.1)
Female	24 (32.9)
Disease
Ulcerative colitis	53 (72.6)
Crohn's disease	20 (27.4)
Mean duration of disease (mo)	42.0±41.6 (4–226)
Mean duration of treatment at DUIH (day)	824.7±538.3 (125–2,086)
Diagnostic hospital
DUIH	50 (68.5)
Others	23 (31.5)
Residence
Goyang city	33 (45.2)
Others	40 (54.8)
Mayo scoring activity index (n=33)	4.1±3.3 (0–12)
Crohn's disease activity index (n=10)	145.8±91.8 (21–330)
Ulcerative colitis (n=53)
Proctitis	16 (30.2)
Left sided colitis	10 (18.9)
Extensive colitis	27 (50.9)
Crohn's disease (n=20)
Colon	8 (40.0)
Small bowel＋ colon	12 (60.0)
Infliximab use	17 (23.3)
Steroid use	47 (64.4)
AZA/6-MP use	28 (38.4)
Antibiotics use	26 (35.6)
Antidiarrhea agent use	23 (31.5)
Operation	13 (17.8)
Hospitalization	34 (46.6)
Disease flare experience	57 (78.1)
White blood cell (×10³/μ L)	7,906±3,154 (3,330–21,410)
Hemoglobin (g/dL)	13.0±2.4 (7.1–18.1)
Mean visit rate (%)	86.7±16.0 (27–100)
Duration of remission (day)	787.7±522.4 (93–1,986)

Values are presented as n (%), mean±SD or median (range). DUIH, Dongguk University Ilsan Hospital; AZA, azathioprine; 6-MP, 6-mercaptopurine.

Table 2.

Clinical Factors Associated with Punctual Visitors for Appointment

Variable	Good visitor (n=38)	Poor visitor (n=35)	p-value
Age (yr)	37.6±13.1	45.8±16.7	0.02
Young age (<45 yr)	29 (76.3)	18 (51.4)	0.03
Male	27 (71.1)	22 (62.9)	0.46
Ulcerative colitis	25 (65.8)	28 (80.0)	0.17
Duration of disease (mo)	41.8±44.6	42.3±38.8	0.96
Mean duration of treatment at DUIH (day)	765.7±572.3	888.8±499.1	0.33
DUIH	25 (65.8)	25 (71.4)	0.60
Residence at Goyang city	14 (36.8)	19 (54.3)	0.14
Infliximab use	11 (28.9)	6 (17.1)	0.23
Steroid use	27 (71.1)	20 (57.1)	0.22
AZA/6-MP use	20 (52.6)	8 (22.9)	0.01
Antibiotics use	16 (42.1)	10 (28.6)	0.23
Antidiarrhea agents use	12 (31.6)	11 (31.4)	0.59
Operation	8 (21.1)	5 (14.3)	0.45
Hospitalization	20 (52.6)	14 (40.0)	0.28
Disease flare experience	32 (84.2)	25 (71.4)	0.19
White blood cell (×10³/μ L)	7,355±2,372	8,505±3,772	0.67
Hemoglobin (g/dL)	12.8±2.7	13.2±2.0	0.42
Duration of remission (day)	718.6±555.6	862.9±480.4	0.24

Values are presented as n (%), mean±SD or median (range).

The factors including age, white blood cell, and hemoglobin, duration of remission were tested by Student's t-test and others were examined by chi-square test or Fisher's exact test.

DUIH, Dongguk University Ilsan Hospital; AZA, azathioprine; 6-MP, 6-mercaptopurine.

Table 3.

Multivariate Analysis of Factors Associated with Punctual Visitors for Appointment

Variable	Odds ratio	95% Confidence interval	p-value
Young age (＜45 yr)	0.40	0.14–1.15	0.09
Ulcerative colitis	1.16	0.34–4.01	0.81
Residence at Goyang city	1.69	0.61–4.65	0.31
AZA/6-MP	3.19	1.12–9.09	0.03
Disease flare experience	2.16	0.60–7.77	0.24

Binary regression logistic analysis was performed by backward conditional method with valuables ＜0.20 from univariate analysis.

AZA, azathioprine; 6-MP, 6-mercaptopurine.

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