Improving Outcomes in Adults with Atopic Dermatitis: Basic Approaches to Adherence Part III of IV

The prior discussion focused on foundational strategies to improve patient adherence, including establishing an environment of care and frequent check-ins with patients after their clinic visit. This section will discuss practical approaches to involving patients in treatment selection, decreasing treatment burden, providing patient education, and strategies to help remind patients to use prescribed therapy (Figure 1).

Patient involvement in selecting therapies highlights their preferences and increases adherence.¹ One patient may prioritize receiving fast results while another patient may value limited adverse effects. The efficacy of a certain medication is irrelevant if a patient is not using it. The best vehicle for drug delivery is the one that the patient will use. Besides inquiring about patient preferences, providing samples of medications for use on a trial basis can be an outstanding way of determining the best treatment before committing to a costly medication. Furthermore, utilizing coupons and discount prescription websites can reduce the monetary burden on patients and convey that you care about the financial impact of the selected treatment regimen.
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Improving Outcomes: Part I – Impact of Nonadherence
Improving Outcomes: Building a Foundation
Treating Head and Neck Atopic Dermatitis
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To reduce the burden of treatment, fewer prescriptions can be given. We have demonstrated that increasing the number of prescriptions inversely correlates with patient adherence.^2,3 Simplifying treatment regimens can be achieved by having patients use a potent treatment on all areas or using it less often on areas that are more responsive to treatment instead of giving multiple prescriptions with different potency to be used on different areas. When more than 1 drug is indicated, using a combination product can reduce the complexity of treatment. The apparent burden of treatment can also be alleviated by reducing the perceived duration of treatment; this can be achieved by having patients report their progress after a few days of treatment

Written instructions help eliminate uncertainty on why and how medications should be used. One out of 3 providers do not provide enough information regarding diagnosis or treatment to allow patients to effectively recall what was discussed during the visit.⁴ Written instructions provide a reference for patients that can be reviewed at any time. In addition, patient portals are an excellent way to provide patients with instructions for medication use as they can easily access this information from their phone and do not have to worry about losing a physical piece of paper. This reduces uncertainty as a cause for inappropriate medication use or lack of use.

Reminders to use prescriptions can be as sophisticated as setting up cell phone alarms or automated text messages, and as simple as instructing patients to put a sticky-note on the bathroom mirror or duct tapping a tube of ointment to their toothpaste. Multiple smart device applications are available to remind patients to use their medications. All of these strategies share a common goal of incorporating a new step into a patient’s daily routine. Making medication use routine can improve the likelihood of treatment adherence.

Parts 1 and 2:

Improving Outcomes: Part I – Impact of Nonadherence
Improving Outcomes: Building a Foundation

References

1. Abraham NS, Naik AD, Street RL Jr, et al. Complex antithrombotic therapy: determinants of patient preference and impact on medication adherence. Patient Prefer Adherence. 2015;9:1657-68.

2. Anderson KL, Dothard EH, Huang KE, Feldman SR. Frequency of primary nonadherence to acne reatment. JAMA Dermatology. 2015;151(6):623-26.

3. Yentzer BA, Ade RA, Fountain JM, et al. Simplifying regimens promotes greater adherence and outcomes with topical acne medications: a randomized controlled trial. Cutis. 2010;86(2):103-8.

4. Storm A, Benfeldt E, Andersen SE, Andersen J. Basic drug information given by physicians is deficient, and patients' knowledge low. J Dermatol Treat. 2009;20(4):190-93.