Faculty
Stephen B. Hanauer, MD
Joseph B. Kirsner Professor of Medicine
Professor of Clinical Pharmacology
Chief, Section of Gastroenterology and Nutrition
The University of Chicago Medical Center
Chicago, Illinois

Richard H. Davis Jr, PA-C
Senior Physician Assistant
Division of Gastroenterology, Hepatology
  and Nutrition
University of Florida College of Medicine
Gainesville, Florida

Learning Objectives
After completing this activity, participants should be better able to:

• Recognize patient- and disease-related factors that increase the risk for treatment nonadherence in patients with Crohn’s disease (CD).
• Integrate patient education about CD into management plans to encourage treatment adherence.
• Implement strategies to increase treatment adherence in patients who are intentionally or unintentionally nonadherent to their prescribed medical therapy.

How to Receive Credit
Participants wishing to earn CME/CE credit must:
•     Read the newsletter.
•     Relate the content material to the learning objectives.
•     Complete the self-assessment questions and the evaluation form
      online at: www.practicingclinicians.com/crohns4test

After login, please enter the code: APCE74510-4
Successful completion of the self-assessment is required to earn CME/CE credit. Successful completion is defined as a cumulative score of at least 70%.
   
The estimated time to complete this activity is 1 hour.
   
Release date: November 7, 2011
Expiration date: November 7, 2012

Introduction
Medical therapy is a cornerstone of treatment for patients with Crohn’s disease (CD). Most often, medical therapy is lifelong and needs to be taken even during periods of quiescent disease or after surgical resection to maintain remission. However, many patients may not appreciate (by virtue of lack of understanding, lack of education, or fear of treatment-related risks) the need for maintenance therapy—in particular when they are feeling well (ie, in remission). Medication nonadherence is thus of common occurrence in patients with CD, with rates as high as 40% at any time point during treatment.¹
      
Nonadherence negatively compromises CD management efforts by leading to poorer outcomes―relapse and decreased quality of life (QOL)―and may also increase healthcare costs. Strategies to improve medication adherence are thus an important facet of CD management. Because nonadherence is common, regular monitoring for subclinical or clinical disease activity is equally important. Monitoring allows disease progression to be detected and treatment to be adjusted according to the stage (activity) of the disease.
      
This issue of PCE Updates on Crohn’s Disease is the final issue of 4 continuing education newsletters on CD. The first issue focused on key strategies for early diagnosis, the second focused on current approaches to medical therapy, and the third focused on the surgical management of CD with special emphasis on postoperative care of patients. This issue reviews treatment nonadherence in patients with CD.

Target Audience
Nurse practitioners (NPs) and physician assistants (PAs) in primary care practice

Activity Goal
To familiarize NPs and PAs in primary care practice with factors that can affect treatment adherence among patients with CD, the consequences of nonadherence, and strategies for improving adherence to medical therapy.

Accreditation Information
The University of Nebraska Medical Center College of Nursing Continuing Nursing Education is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is provided for 1.0 contact hour under ANCC criteria.
   
This program has been reviewed and is approved for a maximum of 1.0 hour of AAPA Category I CME credit by the Physician Assistant Review Panel. Approval is valid for one year from the issue date of November 7, 2011. Participants may submit the self-assessment at any time during that period.
    
This program was planned in accordance with AAPA’s CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs.
    
This activity was supported by an educational grant from Abbott Laboratories and Centocor Ortho Biotech.

Disclaimer
The opinions or views expressed in this continuing education activity are those of the faculty and do not necessarily reflect the opinions or recommendations of Practicing Clinicians Exchange, the University of Nebraska Medical Center College of Nursing Continuing Nursing Education, or Abbott Laboratories and Centocor Ortho Biotech.

Disclosures
All faculty and planners participating in continuing education activities sponsored by the University of Nebraska Medical Center College of Nursing Continuing Nursing Education are expected to disclose to the audience any significant support or substantial relationship(s) with providers of commercial products and/or devices discussed in this activity and/or with any commercial supporters of the activity. In addition, all faculty are expected to openly disclose any off-label, experimental, or investigational use of drugs or devices discussed in this activity. The faculty and planning committee have been advised that this activity must be free from commercial bias, and based upon all the available scientifically rigorous data from research that conforms to accepted standards of experimental design, data collection, and analysis.
    
Mr Davis has nothing to disclose with regard to commercial interests.
Dr Hanauer: clinical research: Abbott Laboratories, Centocor Ortho Biotech Inc., Elan Corporation Inc., Prometheus, Inc., Salix Pharmaceuticals, Inc., Shire, UCB S.A., Warner Chilcott; consultant: Abbott Laboratories, Alaven Pharmaceuticals, Centocor Ortho Biotech Inc., Elan Corporation Inc., Prometheus, Inc., Salix Pharmaceuticals, Inc., Shire, Takeda Pharmaceutical Company Limited, UCB S.A., Warner Chilcott.
    
The Planning Committee for this activity included Catherine A. Bevil, RN, EdD, and Heidi Keeler, PhD, RN, of the University of Nebraska Medical Center College of Nursing Continuing Nursing Education; Mark P. Christiansen, PhD, PA-C, of the University of California Davis Medical Center; and Ruth Cohen and Christine M. Olsen, PhD, of Continuing Education Alliance. The members of the Planning Committee have no significant relationships to disclose.
   
Please contact Practicing Clinicians Exchange at pce@practicingclinicians.com for questions regarding this activity.
   
©2011 Practicing Clinicians Exchange APCE74510-4