In agreement with what occurs with other chronic conditions, significant number of patients with ulcerative colitis fails to comply with treatment. Hawthorne and coworkers reviewed medication nonadherence in inflammatory bowel disease, including the clinical and health service implications in the UK, and discussed strategies for optimizing medication adherence. Articles were identified via a PubMed search, utilizing the words inflammatory bowel disease, adherence, compliance, medication and ulcerative. Medication non-adherence is multi-factorial involving factors other than dosing frequency. Male gender, new patient status, work and travel pressures, and shorter disease duration among other variables are proven predictors of non-adherence in ulcerative colitis. These indicators can identify 'at-risk' patients and allow an individually tailored treatment approach to be introduced that optimizes medication adherence. A collaborative relationship between physician and patient is important; several strategies for improving adherence have been proven effective including open dialogue that takes into consideration the patient's health beliefs and concerns, providing educational (e.g., verbal/ written information, self-management programs), and behavioral interventions (e.g., calendar blister packs, cues/reminders).

VALUE OF ARTICLE TO READER: The authors concluded that educational and behavioral interventions tailored to individual patients could optimize medication adherence. This would likely include putting medication adherence within the framework of teaching self-management skills to patients. Determining the long-term performance of these skills would be the next step to take.

AB Hawthorne et al. Review article: medication non-adherence in ulcerative colitis - strategies to improve adherence with mesalazine and other maintenance therapies. Aliment Pharmacological Therapy, March 31, 2008.