SAN FRANCISCO — For best outcomes in acne patients, address specific factors that affect the likelihood of adherence for an individual and incorporate that information into the larger treatment plan, advises Dr. Christina Kim, a dermatologist at the University of California, Los Angeles.
“On the initial visit, it's worthwhile to spend a little bit of extra time on thinking about patient adherence.” In medicine as a whole, 20%-50% of patients do not take medications as directed. “That number is probably much higher in dermatology, as topical therapies are notorious for their lack of adherence or compliance,” Dr. Kim said at the annual meeting of the Pacific Dermatologic Association.
To assist adherence, consider cost, patient preferences, and convenience. Choose medications that the patient can afford. “Once-daily formulations are more user friendly. If there's an inconvenience aspect to a therapy – like having to take a [product] out of the refrigerator when it's time for application – the likelihood of adherence decreases.”
Patients expect to get better fast – usually within 4-6 weeks – so it's important to explain that acne is a chronic disease, and to describe the time frame for treatment response.
“Usually I tell my patients that my strategy is to improve their acne in the next couple of months with pills. Then they will be on creams for many months after that, to keep their skin clear. Their acne will not go away for several years, and only time will tell when it will resolve,” Dr. Kim said.
If you don't manage patient expectations, they will move on to another physician when the acne doesn't improve as quickly as they want.
“If patients feel they're getting better, they're much more likely to continue treatment. Studies show if a patient is pleased with the physician, if they know that you care, that you are working to improve their disease, they're also more likely to use the treatment that you recommend,” she said.
Discuss with patients not only how to apply their acne medication, but what to do and not do in their non-acne skin care, she added. “If they're using everything under the sun that's over the counter, their skin is going to get irritated, they're not going to continue with their treatment, and adherence will go down.”
Schedule the first follow-up visit soon after the initial visit, she advised. “Even though you don't expect your therapeutics to take effect sometimes for several months, it's worthwhile to see your patient back in 4-6 weeks to see if they are using the products, to see if there are any side effects or any barriers to their use.”
At each visit, ask about adherence, using open-ended, nonjudgmental questions that help establish trust and confidence in your patient. “I usually ask, 'How did you find the treatment? Have you been able to do it? Do you find it bothersome? What about the treatment do you not like? What about the treatment do you like?'” Dr. Kim said.
“It seems obvious, but I think it's something we don't always do. It turns out that when you ask, either verbally or in questionnaires, patients will be very open with you.”
You may discover, for example, that the patient used the samples you provided, but hated the product and didn't buy any more. “That's why their skin didn't get better. They weren't using the treatment,” she said.
Dr. Kim said she had no financial conflicts of interest.
In medicine as a whole, 20%–50% of patients do not take medications as directed.
Source DR. KIM