Abstract Background Complementary and alternative medicine (CAM) use is prevalent among IBD patients with reported usage rates of 21% to 60%.1-3 Prior studies in IBD have shown variable compliance to prescribed therapies in CAM users compared to non-CAM users. It is unknown whether CAM use is associated with increased healthcare service utilisation and whether this is mediated by medication non-adherence. We aimed to investigate the relationship between CAM use and a) medication adherence and b) any IBD related unplanned emergency department (ED) presentations or hospitalizations. Methods Consecutive patients from a tertiary IBD clinic were invited to complete a survey assessing adherence to prescribed IBD medications using the Modified Morisky Scale (MMAS-8), use of CAM, a range of sociodemographic and disease-related variables. A chart review identified unplanned ED visits and hospitalizations over the preceding five years for each respondent. Univariate analyses were performed to compare sociodemographic and disease characteristics between CAM users and non-users. Multivariate logistic regression controlled for confounding variables for the primary outcome (ED presentation or hospitalisation). Results 474 patients completed the survey, and 89 patients (18.8%) were found to be active CAM users. Oral homeopathic remedies were the most frequent CAM used (21.1%). On univariate analysis, CAM users; were more frequently female (74.2% vs. 53.8%, P 0.001); more frequently held a tertiary or postgraduate qualifications (41.6% vs. 21.9%, P 0.001); more frequently experienced side effects from prescribed medications (53.0% vs. 30.9%, P 0.001) and had a greater prevalence of a mental health condition (50.6% vs. 29.9%, P 0.001), compared to non-CAM users. Numerically more CAM users took recreational drugs (12.4% vs 6.8%, P = 0.08). CAM users were more likely to have an IBD related ED presentation or hospitalisation (42.7% vs 24.2%, P 0.001), however MMAS scores were not different (P = 0.56) and there was no difference in disease characteristics (IBD type, disease duration, active advance therapy/ immunosuppressant/ corticosteroid use and number of prior intestinal resections) in both groups, P 0.05. An unplanned IBD related ED presentation or hospitalisation was independently associated with the presence of a mental health condition (OR = 1.8 95%CI: 1.2-2.8, P = 0.005) and being an active CAM user (OR = 2.3 95%CI (1.4-3.5, P = 0.002) on multivariate analysis. Conclusion IBD medication nonadherence is not affected by CAM use; however, CAM use and having a mental health condition is highly associated with an unplanned IBD related ED presentation or hospitalisation. A thorough history of CAM use in IBD patients should be underscored during clinical assessment. References: 1. Oxelmark L, Lindberg A, Lofberg R, Sternby B, Eriksson A, Almer S, et al. Use of complementary and alternative medicine in Swedish patients with inflammatory bowel disease: a controlled study. Eur J Gastroenterol Hepatol. 2016;28(11):1320-8. 2. Torres J, Ellul P, Langhorst J, Mikocka-Walus A, Barreiro-de Acosta M, Basnayake C, et al. European Crohn’s and Colitis Organisation Topical Review on Complementary Medicine and Psychotherapy in Inflammatory Bowel Disease. J Crohns Colitis. 2019;13(6):673-85e. 3. Zezos P, Nguyen GC. Use of Complementary and Alternative Medicine in Inflammatory Bowel Disease Around the World. Gastroenterol Clin North Am. 2017;46(4):679-88. Conflict of interest: Goel, Prisha: No conflict of interest Li, Angel: No conflict of interest Dr. Thin, Lena: Pfizer- advisory board fees, research grants Takeda- research grant, advisory board fees JNJ- advisory board fees Abbvie- advisory board fees Neuroscientific - advisory committee Celltriom- advisory board fees
Goel et al. (Thu,) studied this question.