Journal List > Korean J Gastroenterol > v.61(6) > 1007098

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

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.

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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.
kjg-61-313f1.tif
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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