Is budesonide on demand an option for microscopic colitis treatment? A qualitative study on patient's perspective.

Background: Budesonide is the standard treatment for microscopic colitis (MC), effectively alleviating diarrhoea. However, diarrhoea recurrence upon discontinuation raises ideas about the feasibility of on-demand treatment. While self-management is emphasized in care of chronic diseases, less is known about patients' perspectives on initiating budesonide on-demand.

Method: A qualitative study was conducted using semi-structured interviews with 15 patients diagnosed with MC and previous experience with budesonide treatment. Data were analysed using qualitative content analysis to explore patients' perceptions of on-demand treatment.

Results: Three main categories emerged: (1) Self-management and confidence in handling flares: Patients expressed a strong desire for self-management, valuing the ability to initiate treatment independently during flares. However, some were hesitant due to uncertainty about proper dosing and treatment duration. (2) Perceptions of budesonide and attitudes towards medication: While budesonide was perceived as highly effective, concerns about long-term use, side effects, and potential loss of efficacy influenced adherence. Some adjusted doses based on diarrhoea, while others preferred guidance from their physician before initiating treatment. (3) The role of healthcare in treatment decisions: Patients emphasized the importance of accessible healthcare, clear treatment guidelines, and structured follow-up. Many felt that healthcare providers focused primarily on prescribing medication rather than providing a holistic approach. A model integrating person-centred care with professional guidance was seen as ideal for optimizing treatment outcomes.

Conclusion: On-demand budesonide treatment could provide patients with greater flexibility but requires individualized support. A structured approach that balances self-management with follow-up and person-centred guidance may enhance adherence and improve quality of life in patients with MC.