Promoting Treatment Adherence in Pediatric Inflammatory Bowel Disease

描述（由申请人提供）：

DESCRIPTION (provided by applicant): Research on medication adherence in pediatric Crohn's disease and ulcerative colitis, collectively inflammatory bowel disease (IBD), has demonstrated nonadherence rates ranging from 50-88% across medications. These data are alarming given that 1) the risk of relapse in IBD is 5.5 times greater in nonadherent patients than in adherent patients, 2) the annual costs of health care in nonadherent IBD patients are 12.5% higher, and 3) the estimated annual cost of nonadherence in US health care is $100-300 billion. Factors related to poor adherence include deficits in knowledge about IBD and medications used for treatment, organizational barriers, and behavioral problems in adolescents and/or their families. Thus, nonadherence is a complex and significant health care issue in IBD, requiring effective multicomponent behavioral intervention to improve treatment outcomes. Preliminary evidence suggests that a family-based group behavioral treatment improves adherence in adolescents with IBD, is viewed favorably, and is well-attended by patients and families, which is consistent with group interventions for nonadherence in other populations. However, because group treatment necessarily targets behaviors that are common across "typical" patients, individual patient and family adherence barriers may not be optimally addressed. Researchers have acknowledged that individually-tailored behavioral treatments are advantageous because of their ability to analyze and target specific behaviors that functionally maintain nonadherence, which vary across patients; yet, the additive benefit of individually-tailored treatment combined with group intervention has not been examined. This is a critical step in determining optimal treatment of nonadherence in pediatric IBD. Thus, the proposed study aims to pilot test the feasibility and preliminary efficacy of a novel treatment approach involving supplementation of an existing family-based group behavioral intervention protocol with an individually-tailored treatment component to optimize medication adherence and improve disease severity and health-related quality of life. This Group + Individually-tailored (Group+IT) intervention will incorporate intensive functional behavioral analysis of adherence barriers and use cellular telephone technology that provides automated behavioral prompts in order to encourage patient engagement and maximize the efficacy of this innovative behavioral treatment. Participants in the Group+IT treatment will be compared to participants in a Group only treatment. Twenty-four adolescents (13-17 years of age) and their parents will be enrolled in the study. Given the prevalence of nonadherence in IBD and the health and economic impact of nonadherence, this study is timely and important, as it has the potential to optimize behavioral treatment of nonadherence and positively impact IBD health outcomes. PUBLIC HEALTH RELEVANCE: A large number of adolescents with inflammatory bowel disease (IBD) have significant difficulty managing their illness effectively. Factors that contribute to poor self-management and health outcomes include deficits in knowledge about IBD and medications used for treatment, organizational barriers, and behavioral problems in adolescents and/or their families. This study proposes a novel group + individually-tailored intervention to improve treatment self-management, disease severity, and health-related quality of life in pediatric IBD.