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School of Medicine
Inside Tract - Why That IBD Prescription May Not Be Working
Inside Tract Summer 2010
Why That IBD Prescription May Not Be Working
Date: August 31, 2010
“Any time you have a chronic disease,” says Sharon Dudley-Brown, “the adherence rate drops. Even Hippocrates believed that his patients faked compliance.”
For half of her life, the 60-year-old had suffered from ulcerative colitis. Despite having been prescribed mesalamine by her local gastroenterologist, she still had frequent bouts of pain and diarrhea.
Her flare-ups finally brought her to Johns Hopkins, where she met with Sharon Dudley-Brown, a Ph.D. nurse practitioner and researcher, who specializes in helping patients who have inflammatory bowel disease to follow drug regimens. Dudley-Brown sat down with the woman to try to figure out what was wrong—and the answer was discovered almost immediately.
“She told me she would take her medication whenever she was having problems,” says Dudley-Brown. “When I explained that she needed to take her medication every day, regardless of how she felt, she replied, ‘nobody ever told me this.’”
Dudley-Brown’s ability to improve adherence to IBD medication regimens stems in part from her research on and experience with the reasons patients don’t take their medications. Among them are demographics (young patients are less adherent), the complexity of the regimen, and the level of pain (or symptoms) the patient experiences. Dudley-Brown can show patients hard statistics about relapse and remission rates for those who do take their medications correctly: An initial 2003 study found that patients with ulcerative colitis who adhere to mesalamine have an 89 percent rate of remission.
The best chance to achieve adherence, Dudley-Brown finds, comes from engaging patients as people. “If you give them the opportunity to communicate and make it clear that you’re not going to bite their head off if they tell you they’re not taking their medication,” she says, “they’ll tell you the truth.”
Sometimes it’s as basic as explaining how the medication works, like it was for the 60-year-old with ulcerative colitis. “She wasn’t purposefully not adhering to the regimen,” Dudley-Brown says. “It was simply that no one had made sure she understood that she needed to take the medication every day. Now, she’s been taking her medication daily for two years, and it’s the only one she takes. And she hasn’t had a flare-up in two years.”