Compliance is critical to the foundation of high quality IBD care. However, many studies rely on self-reported compliance metrics without corroboration. Pediatric to adult transition of care in IBD is a challenging period during which compliance is compromised. To determine the impact of transition age (18–25) on non-compliance. A retrospective cohort study was performed using data from a sample of gastroenterology patients (n=245) recorded in the electronic medical record between January 1, 2015 and June 30, 2017. Data was extracted between July 1st, 2017 and August 31st, 2017. Data on patient sex, age at last encounter (separated into 4 categories), age of diagnosis, residential address, disease type, comorbidities, medications, substance use, family history of IBD and markers of non-compliance were collected. Single variable logistic regression was used to determine the impact of age category on compliance. Multivariable logistic regression was used to investigate the likelihood of non-compliance depending on age category while adjusting for baseline characteristics. 245 patients were included and separated (18–25 (n=27), 26–45 (n=109), 46–65 (n=84), >65 (n=25)). 49% had Crohn’s Disease (CD), the mean age at last interaction was 43 +/-15, mean age of IBD diagnosis 31 +/-14, 54% were on biologic therapy, 53% had another non-IBD related comorbidity, 50% reported some form of substance use, 33% had a family history of IBD. The 18–25 group was more likely to not show up for a follow-up visit (33% vs 23% vs 11% vs 12%, p=0.002), not show up to a GP appointment (30% vs 29% vs 25% vs 28%, p=0.0081), arrive late to a GI appointment (56% vs 53% vs 45% vs 48%, p=0.001). They were less likely to cancel a GI appointment in advance (56% vs 66% vs 58% vs 56% p=0.002). Patients aged 18–25 were less likely to volunteer self-discontinuation or inconsistent use of medications, as documented in the physician notes (19% vs 42% vs 43% vs 44%, (p=0.002) and were more likely to have no documented non-compliance in the physician notes (59% vs 41% vs 34% vs 44%, p=0.0002). When focusing on no-show, late arrivals or cancelled visits, a multivariable logistic regression model revealed that all other age categories demonstrated less non-compliance compared to the 18–25 age group (26–45 years OR -1.50 [-2.24,-0.75], 46–65 years OR -2.57 [-3.43,-1.72], >65 years OR -2.62 [-3.61,-1.63]. However, when focusing only on physician documented non-compliance, multivariable logistic regression model did not reveal age as a significant predictor. Transition aged patients 18–25 show more objective forms of non-compliance but are less likely to volunteer their non-compliance in physician interactions, making self-reported compliance metrics unreliable. Department of Medicine, Women’s College Hospital
No takes yet. Share an insight, caveat, or question.
Bollegala et al. (2019) studied this question.