Mild-to-moderate ulcerative colitis: your role in patient compliance and health care costs.

BACKGROUND: Ulcerative colitis (UC) is a chronic relapsing disease necessitating lifelong treatment. Most patients present with mild-to-moderate disease characterized by alternating periods of remission and clinical relapse. Continued disease progression and relapse of UC over time are associated with an increased risk of colorectal cancer (CRC). OBJECTIVE: To discuss the latest treatment options for mild-to-moderate UC, to review the current data involving the economics of UC, and to demonstrate the relationship between treatment adherence, clinical relapse, inflammation severity, CRC risk, and treatment outcomes. SUMMARY: One of the main goals of therapy in UC is to induce and maintain a long-lasting remission of disease to reduce or avoid the high personal and financial costs of relapse. In recent studies, researchers have demonstrated a link between increased colonic inflammation and CRC risk, highlighting the importance of preventing relapse, which can lead to costly surgical procedures and hospital stays and thus increase the cost of treatment 2- to 20-fold. The risk of disease relapse is affected by several factors, of which the most prominent is nonadherence to maintenance therapy. Nonadherence to therapy can be associated with several other factors, including forgetfulness, male sex, complicated dosing regimens, treatment delivery methods (oral vs. rectal), and pill burden. In the treatment of mild-to-moderate UC, 5-aminosalicyclic acid (5-ASA) is the standard first-line therapy and the treatment of choice for maintaining remission of disease. Novel formulations of 5-ASA and newly devised high-dose 5-ASA regimens offer more options for the treatment of UC and thus may lead to improved treatment adherence, longer remission, and improved patient well-being. CONCLUSION: Periods of remission during UC treatment must be aggressively maintained to prevent relapse and decrease the risk of an unfavorable outcome. By controlling the risks and conditions that lead to therapeutic nonadherence and relapse among patients with UC, clinicians can increase the likelihood of long-term remission and ensure favorable long-term outcomes.

New approaches to adherence issues when dosing oral aminosalicylates in ulcerative colitis.

PURPOSE: Adherence issues with the use of available aminosalicylates for the treatment of ulcerative colitis (UC) are discussed. SUMMARY: In the clinical setting, adherence to aminosalicylate therapy has been less than optimal. Topical formulations are associated with poor retention, abdominal bloating, and discomfort during administration. Although oral formulations are more convenient than topical formulations, many require multiple-daily-dosing regimens and have a high pill burden, which make patient adherence poor. A number of oral aminosalicylate formulations use colonic bacteria to release the active drug. Although these oral formulations are effective for the treatment of active UC, therapy is not optimal with regard to clinical outcome. Because of the short half-life, the vast majority of current therapies require multiple daily dosing. In addition, the dose strength of these formulations ranges from 250 to 500 mg, which requires patients to take several tablets at a time. Some patients may also require additional topical aminosalicylate to maintain treatment efficacy. However, many patients dislike topical formulations, and refill rates have been shown to be much lower than with oral formulations. New aminosalicylate formulations are now being designed to improve dosing schedules and increase patient adherence, potentially improving clinical and economic outcomes. High-dose, oral mesalamine formulations have been designed to reduce pill burden. CONCLUSION: While aminosalicylates are recommended as first-line treatment for the reduction of symptoms and the prevention of relapse in patients with mild-to-moderate UC, many available formulations require patients to take multiple tablets or capsules two to four times daily, which may affect adherence. New dosage regimens and delivery systems have been developed or are under development to improve convenience of dosing and potentially improve adherence.

Improving medical students' knowledge of systems-based practice.

Systems-based practice is an important aspect of medical education. This study evaluates the effectiveness of an eight-hour intervention on medical students' knowledge of the principles of managed care. A pre-test on basic managed care principles was administered to freshman medical students at Mercer University. After an eight- hour managed care curriculum was presented to these students, a post-test was administered. The pre-test and post-test scores on the material increased a mean score of 9.7 points (p < 0.001). Our conclusion is that providing as little as eight-hours of instruction on managed care topics can significantly improve first-year medical students' knowledge and understanding of systems-based practice.