| dc.description.abstract | Background and Objectives: Approximately 50% of children and only 25 to 35% of adolescents with Inflammatory Bowel Disease (IBD) show adequate medication adherence. Good medication adherence is necessary to lower disease activity and elongate periods of remission. The objective of the study was to assess the effect of the smartphone application MedicijnWijs on adherence to azathioprine therapy in IBD patients aged 12 up to and including 17 years old. The effect on knowledge about IBD and the ease of use of MedicijnWijs were studied as well.
Methods: A multicenter before-and-after study was conducted in three top clinical hospitals in the Netherlands. The participants used MedicijnWijs for six weeks. At the beginning and the end of the study, participants filled in two validated questionnaires: the Medication Adherence Report Scale-5 (MARS-5), which tested the participants’ adherence to azathioprine therapy, and the Inflammatory Bowel Disease Knowledge Inventory Device 2 (IBD-KID2), which tested the participants’ knowledge about IBD. Potential changes in the scores compared to baseline were assessed. The ease of use of MedicijnWijs was assessed separately at the end of the six-week period.
Results: An interim analysis of the data of the Máxima Medical Center (MMC) cohort was conducted, since the total dataset was not yet available at the time of analysis due to delays in the other two hospitals. Seven participants were included between March 2022 and April 2022. The geometric mean age was 15.6 years old (IQR = 15.0-17.0), four participants (57.0%) were female, two (28.6%) had Ulcerative Colitis (UC), three (42.8%) Crohn’s Disease (CD), and two (28.6%) IBD unclassified (IBD-U). Two participants were lost to follow-up. The required sample size for generating a power of 80% was not achieved (only 7 out of 21 participants; 33.3%). A Wilcoxon signed-rank test showed a non-significant difference in the MARS-5 score before (geometric mean = 23.0, IQR = 22.5-23.5) and after the use of MedicijnWijs (geometric mean = 23.2, IQR = 22.5-24.0); Z = -0.272, P = 0.785. Time since diagnosis was significantly positively correlated with the MARS-5 score at baseline (r = 0.894, P = 0.041). A Wilcoxon signed-rank test showed a non-significant difference in the IBD-KID2 score before (geometric mean = 7.9, IQR = 6.0-11.0) and after the use of MedicijnWijs (geometric mean = 9.2, IQR = 6.5-12.5); Z = -0.730, P = 0.465. No other independent variable was significantly associated with the MARS-5 or IBD-KID2 scores of the participants. Overall, the ease of use of MedicijnWijs was rated high.
Conclusions: No hard conclusions can be drawn from the study since most results were not statistically significant. Overall, positive trends were observed in improving adherence to azathioprine therapy and knowledge about IBD. In the remainder of the study, the potential of MedicijnWijs will be further investigated in a multicenter setting. | |
