34 Aims and Methods Non-compliance with medication is a clinically important problem in children with chronic diseases. Reported compliance rates for longterm drug therapy vary from 11% to 83%. Non-compliance can compromise the efficacy of medication regimens, leading to increased morbidity. Most children with chronic inflammatory bowel disease (IBD) have a life-time prescription of mesalazine, in order to prevent disease exacerbation. Aim of this study is to assess the compliance rate for mesalazine in our population of children with IBD. Secondly, the effectiveness of an educational and behavioural intervention, designed to enhance drug compliance, is evaluated in these children. From September 1997 to January 1998, all children visiting the IBD outpatient clinic were asked to participate in the study. Children were included (by child preference) in either a long study (20 weeks) or a short study (8 weeks), and were submitted to the compliance-enhancing intervention for 6 or 2 weeks, respectively. This intervention consisted of extensive information on medication, constant support and reinforcement for adherent behaviour, as well as a self-monitoring system. In both study designs, compliance was assessed weekly by non-judgemental medical students, using two methods: pillcounts and patient and parent interviews. Compliance rate before, directly after and (in the long study) 8 weeks after the intervention was calculated from both methods. Results In total, 17 IBD (Crohn's disease: n=9, ulcerative colitis: n=8) patients were included in both study designs (long study: n=10, short study: n=7). Mean age was 10.1 yr. and 13.1 yr., respectively. In the first group, disease severity was somewhat worse and frequency of yearly outpatient clinic visits was higher (6.2/year vs. 4.0/year) than in the second group. In both groups, compliance rate varied highly intra-individually. However, mean compliance rate (by pillcount) was exceptionally high (90%). Compliance rate assessed by interviews varied from 60%-93%. Educational and behavioural intervention did not enhance compliance, measured by pill count or interview, any further in any of the children. Conclusions In our study population of children with IBD, mean compliance rate by pill count was surprisingly high (90%), while assessment by interviews showed lower rates in all patients. This may be attributed to the design of the questionnaire, which is a very sensitive tool to detect non-compliance. A strategy designed to increase compliance rate by educational and behavioural methods was not effective. The high rate of compliance could be the result of frequent visits to our small academic outpatient clinic with consistency in treating physicians. It may also mirror the study effect on compliance, as well as non-objectiveness of assessment methods.
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Escher et al. (1999) studied this question.