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Adherence to systemic therapies for immune-mediated inflammatory diseases in Lebanon: a physicians’ survey from three medical specialties

Authors Ammoury A, Okais J, Hobeika M, Sayegh RB, Shayto RH, Sharara AI

Received 14 October 2016

Accepted for publication 14 March 2017

Published 15 May 2017 Volume 2017:11 Pages 939—945

DOI https://doi.org/10.2147/PPA.S124721

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Alfred Ammoury,1 Jad Okais,2 Mireille Hobeika,3 Raymond B Sayegh,4 Rani H Shayto,5 Ala I Sharara5

1
Division of Dermatology, St George Hospital University Medical Center, 2Division of Rheumatology, St Joseph University, 3AbbVie Levant, 4Division of Gastroenterology, St Joseph University, 5Department of Internal Medicine, Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon

Background: Immune-mediated inflammatory diseases (IMIDs) are chronic conditions that may cause tissue damage and disability, reduced quality of life and increased mortality. Various treatments have been developed for IMIDs, including immune modulators and targeted biologic agents. However, adherence remains suboptimal.
Methods: An adherence survey was used to evaluate physicians’ beliefs about adherence to medication in IMID and to evaluate if and how they manage adherence. The survey was distributed to 100 randomly selected physicians from three different specialties. Results were analyzed by four academic experts commissioned to develop an action plan to address practical and perceptual barriers to adherence, integrating it into treatment goals to maximize outcomes in IMID, thereby elevating local standards of care.
Results: Eighty-two physicians participated in this study and completed the questionnaire. Most defined adherence as compliance with prescribed treatment. Although the majority of surveyed physicians (74%) did not systematically measure adherence in their practice, 54% identified adherence as a treatment goal of equal or greater importance to therapeutic endpoints. Lack of time and specialized nursing support was reported as an important barrier to measuring adherence. The expert panel identified four key areas for action: 360° education (patient–nurse–physician), patient–physician communication, patient perception and concerns, and market access/cost. An action plan was developed centered on education and awareness, enhanced benefit–risk communication, development of adherence assessment tools and promotion of patient support programs.
Conclusion: Nonadherence to medication is a commonly underestimated problem with important consequences. A customized target-based strategy to address the root causes of nonadherence is essential in the management of chronic immune-mediated diseases.

Keywords: biologics, compliance, Crohn’s disease, psoriasis, rheumatoid arthritis

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