While adherence has been studied in several different areas of medicine, there are fewer published articles regarding adherence in dermatology. Moreover, adherence to topical therapy is difficult to quantify and measure reliably; yet a small number of studies have demonstrated that dermatology patients have low adherence rates to treatment regimens—in part due to ‘socioeconomic, cognitive, and psychological factors’ that contribute to non-adherence.
Nevertheless, in addition to improving patient knowledge, coupled with enhancing the relationship between doctor and patient, there are specific supplementary strategies that can be implemented to ensure compliance. According to Steven R. Feldman, MD, PhD, professor of dermatology, pathology, and public health sciences at Wake Forest University School of Medicine, a comprehensive approach is needed to change behavior. Feldman recommends establishing a system to encourage adherence from the first, initial visit. By focusing on the right compliance protocol, clinicians might be as effective in helping patients comply & continue with treatment as they are in providing a diagnosis.
Often, when patients do not implement a clinician’s guidance, it stems from reasons including lack of motivation, distrust of the physician/clinician, fear of the specific medicine and/or treatment, a belief that the treatment is more burdensome than the disease, etc. Yet Feldman insists that it is possible to improve how well patients follow instructions, and in remarks at the American Academy of Dermatology 2018 Summer Meeting, he suggested the following tips & techniques to help create an ‘adherence protocol:’
- Schedule Follow-Ups: Because patients are more apt to utilize medications and fill prescriptions if they have scheduled subsequent follow-ups, Feldman cited a study that indicated a 1-week return visit was more effective in prompting children to apply 0.1 tacrolimus ointment than either parent or electronic reminders
- Simplify Treatment: The treatment should be as easy to follow as possible; if it requires complex—or too many—steps, patients are less likely to follow
- Offer Written Plan: Patients are more likely to follow written instructions that include treatment tips, details on managing flare-ups, and an explanation of conditions
- Implement Creative Triggers: Digital and/or calendar reminders can be “effective tools in facilitating patient compliance,” and other ‘barrier’ triggers (i.e. weekly pill boxes) can also prove helpful
- Employ Creative Motivation: For young children, positive feedback (such as sticker charts) can be both enjoyable and helpful
- Share Anecdotes: Share success stories that might help patients feel comfortable with a treatment