National differences in ulcerative colitis experience and management among patients from five European countries and Canada: an online survey.

Stefan Schreiber, Julián Panés, Edouard Louis, Derek Holley, Mandy Buch, Kristine Paridaens
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Journal of Crohn's & colitis : international journal devoted to inflammatory bowel diseases
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Patients'' and physicians'' perceptions of ulcerative colitis and its management are important for developing and guiding appropriate therapies. This study explored national differences in patients'' and physicians'' experiences, expectations, and beliefs about ulcerative colitis.Structured, cross-sectional, online surveys evaluating various indices were completed by 775 adult patients with ulcerative colitis and 475 physicians actively managing ulcerative colitis patients from France, Germany, Ireland, Spain, the United Kingdom, and Canada.Patients'' classification of their symptom severity differed across countries (mild, 16%-45%; moderate, 46%-58%; severe, 4%-36%). Expectations of disease control also varied, with 26% (Ireland) to 65% (Spain) describing that remission realistically involves "living without symptoms." Within each country, more patients (45%-69%) than physicians (28%-45%) considered ulcerative colitis symptoms to affect patients'' quality of life. Mean number of patient-reported flares during the past year ranged from 2.5 in Ireland to 8.0 in France. Self-reported adherence with oral 5-aminosalicylic acid (during remission) was highest in Spain (91% vs 50%-73% across other countries). Spanish patients were more likely to self-adjust their medications (54% vs 2%-5%), but reported the most dissatisfaction with therapy (42% vs 9%-27%). Irish patients were least likely to arrange physician/specialist nurse visits (14% vs 36%-49%) and least open to discussion of their condition.Important national differences in ulcerative colitis patients'' attitudes and perceptions were observed, which may help physicians improve patient care based on country-specific needs and influence self-assessments in clinical trials. The results suggest a need for structured patient education to improve adherence and outcomes.