P4361 - Treat to Target Recommendations and Adherence in Inflammatory Bowel Disease: Patient Experiences and Perspectives

Frank I.. Scott, MD, MSc(Epi)¹, Jason K. Hou, MD, MS, FACG², Jared Sninsky, MD, MSCR², Donald Lum, MD, FACG³, Dana J. Lukin, MD⁴, Ann D. Flynn, MD, FACG⁵, Corey A.. Siegel, MD, MS⁶, Gil Y. Melmed, MD⁷, Alandra Weaver, MPH⁸, Danielle Duran, MA⁹, Sarah E. Brewer, PhD, MPA^1
1University of Colorado Anschutz Medical Campus, Aurora, CO; ²Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; ³The Oregon Clinic, Portland, OR; ⁴Jill Roberts Center for Inflammatory Bowel Disease, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY; ⁵University of Utah, Salt Lake City, UT; ⁶Dartmouth-Hitchcock Medical Center, Lebanon, NH; ⁷Cedars-Sinai Medical Center, Los Angeles, CA; ⁸Crohn's and Colitis Foundation, New York, NY; ⁹University of Colorado School of Medicine, Aurora, CO

Introduction: “Treat-to-Target” (T2T) monitoring allows for proactive laboratory monitoring to guide treatment modifications in inflammatory bowel disease (IBD), with the goal of improving response and remission rates and decreasing healthcare utilization. T2T adherence remains low. We sought to understand the perspectives of patients living with IBD in relation to T2T monitoring and the factors that support and inhibit T2T adherence.



Methods: Using a modified grounded theory methodology, we conducted online focus groups (FG) with patients receiving treatment for IBD at 5 sites within IBD Qorus, a nationally recognized quality of care collaborative within the United States. FGs were conducted by Zoom, lasted ~90 minutes, and explored patients’ understanding of T2T, monitoring and treatment decision-making, barriers and facilitators to T2T adherence, and insurance coverage for monitoring and testing. FGs were recorded, transcribed, and entered into ATLAS.ti. We mined field notes and reviewed transcripts to identify emergent topics, conducted open coding, then used axial and selective coding to develop categories. Data were synthesized into core themes.



Results: 29 patients from 5 sites participated in 7 total FG with an average of 4 patients per group, with 45% female. Our analysis revealed four main themes influencing low T2T uptake and adherence among patients: 1) patients had not heard of or understood T2T approaches; 2) patients find monitoring including lab testing and imaging inconvenient and cumbersome; 3) healthcare costs for patients were particularly challenging for overall management of IBD; and 4) patients rarely get reminders to complete follow-up testing (Table 1).



Discussion: Improving T2T monitoring adherence is imperative to maximize the benefit of advanced therapies in IBD. Our findings demonstrate that providers could incorporate a more definitive discussion of T2T care, explaining why labs or imaging are being ordered. Scheduling and logistics for testing can act as a barrier to adherence as well. This could be mitigated through more focused IBD care coordination and patient reminders. Costs related to co-pays for testing or drugs and incomplete prior authorizations add a financial barrier to adherence. Incorporating prior authorization processes and co-pay assistance programs into IBD care coordination can help to reduce this burden. These data demonstrate that several domains could be targeted to improve adherence to T2T care in IBD.




Disclosures:


Frank I.. Scott, MD, MSc(Epi)¹, Jason K. Hou, MD, MS, FACG², Jared Sninsky, MD, MSCR², Donald Lum, MD, FACG³, Dana J. Lukin, MD⁴, Ann D. Flynn, MD, FACG⁵, Corey A.. Siegel, MD, MS⁶, Gil Y. Melmed, MD⁷, Alandra Weaver, MPH⁸, Danielle Duran, MA⁹, Sarah E. Brewer, PhD, MPA¹. P4361 - Treat to Target Recommendations and Adherence in Inflammatory Bowel Disease: Patient Experiences and Perspectives, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.