Correlative Study On Medication-adherence,Efficacy And Physical And Mental Health In Patients With Crohn's Disease

BACKGROUND AND AIMS: Patients with Crohn's disease(CD)are not only suffering from the physical impairments,but also experienced the reduced health-related quality of life(Qo L),negative body image(BI)and lower self-esteem(SE).In the first part,we evaluate occurrence of active perianal fistulizing in Crohn's disease(APFCD)patients on psychological health and therapeutic effects of A-TNF-? agent(Infliximab,IFX)both on improvement of fistula and physical-mental status.The Second part aims to determine the risk factors of non-adherence in patients with CD with Azathioprine(AZA)as maintenance therapy.The influence of patients' educational program on the adherence of AZA as maintenance drug is also investigated.METHODS: The first part of the article retrospectively enrolled confirmed CD patients.Demographic and clinical characteristics and various questionnaire scoring were collected and statistical comparisons were conducted between APFCD and non-APFCD groups,chiefly in terms of Qo L,BI,SE.Then,further exploration was mainly focusing on influence of IFX therapy on improvement of psychological-social status in APFCD patients.The second part enrolled patients with AZA as maintenance therapy in CD.Demographic,clinical data and regime information were collected.Univariate and multivariate analysis were performed to identify the risk factors of non-adherence.Then we conducted a patients' educational program.One year after the program,the improvements of adherence were compared between educational and non-educational groups in terms of clinical manifestation,endoscopic improvement and relapse rates.RESULTS: As for the first part,a total of three hundred and one CD patients were retrieved from our database.30.2%(91/301)of the patients had active perianal fistulas.Eighty six APFCD patients were analyzed in this study.After adjusting with Propensity Score Matching(PSM),we found that APFCD patients had lower SE score and higher BI score compared with non-APFCD patients(P<0.05,respectively).Patients with perianal fistula(PF)remission had significantly greater improvements in Qo L,BI and SE scores compared with APFCD group(P<0.05,respectively).In IFX group,the PF remission rate was 68.3%,which was significantly higher than in non-IFX group(P=0.005).Furthermore,improvements of Qo L,BI and SE in IFX group were significantly greater than that in non-IFX group(P<0.05,respectively).In the second part,a total of 378 patients were analyzed.Non-adherence occurred in 43.9%(166/378)patients.Univariate analysis revealed that younger age,less-educated,alcoholism,anxiety,depression,concerns belief,lack of necessity belief and knowledge were risk factors responsible for non-adherence(P<0.05,respectively).Multivariate analysis indicated that anxiety(OR6.244,95% CI 2.563-15.213),depression(OR 3.801,95% CI 1.281-11.278)and concerns belief(OR 19.531,95% CI 3.393-120.732)were independent risk factors of non adherence.Necessity belief(OR 0.961,95% CI 0.925-0.999)and knowledge(OR 0.823,95% CI 0.758-0.903)were protective factors of adherence.Under AZA educational program,necessity belief,knowledge and adherence of educational group were significantly improved(P<0.05,respectively).Concerns belief was significantly lower in educational group(P < 0.05).Moreover,The non-educational group possessed significantly higher endoscopic relapse rate(15.9% vs 30.1%,P=0.035).CONCLUSIONS: Patients with APFCD had lower BID,lower SE and.PF remission could alleviate BI and improve SE,Qo L.IFX had positive efficacy on perianal fistula which could consequently improve patients' BI,SE and Qo L.Non-adherence occurred frequently in CD patients with AZA as maintenance therapy.The educational program could improve patients' adherence mainly by means of promoting their beliefs,knowledge to AZA and reduce relapse rate during treatment.