patient care perspectives

Helping Patients to Use Their Psoriasis Medications as Recommended

by Steven R. Feldman, MD, PhD

Overview

Nonadherence to psoriasis treatment is common and leads to negative therapeutic outcomes. Multiple approaches may be needed to encourage patients to be adherent with their psoriasis treatment, including those that employ frequent follow-up and emphasize accountability.

Expert Commentary

Steven R. Feldman, MD, PhD

Professor of Dermatology, Pathology, and Social Sciences & Health Policy
Wake Forest School of Medicine
Winston-Salem, NC 

“Clinicians should think of ways to trigger patients to take their medications; however, more importantly, I think that this is an accountability phenomenon. Patients must be held accountable.”

Steven R. Feldman, MD, PhD

Medication noncompliance is common, and it encompasses not only remembering to take the medication but also taking it at the right time, in the right way. Even when patients have severe skin involvement, are motivated to succeed, and are given a highly effective biologic for self-administration, noncompliance can still be an issue.

I spend a lot of time in my practice figuring out why patients are not using their medicine, and, in my opinion, the number one most important factor is that doctors are terrible at getting patients to use their medication(s). We do not hold patients accountable, and so, I think that it is our fault when they do not use their medicines. We need to do something more than simply telling our patients to “do this every day, and we’ll see you in 2 to 3 months.”

Clinicians should think of ways to trigger patients to take their medications; however, more importantly, I think that this is an accountability phenomenon. Patients must be held accountable. Instead of telling them that you will see them in 2 to 3 months, you should tell them that you will see them in 1 week. If you are not able to see them in 1 week, then you should ask the patient to call you and leave a message about how they are doing. Nowadays, you do not have to use your cell phone if you have an electronic medical record system through which patients can send you a message through the portal at their check-in time. To whatever extent patients know that they are going to be talking to a doctor who is checking up on them, I think that they use their medication(s) that much better.

You also have to consider how you explain risk to patients. Rather than telling them that there is a 1 in 1000 risk of an adverse reaction, many physicians say that 999 out of 1000 patients do not have the reaction, and that is completely reassuring to patients. Similarly, if an individual has heard of a friend or relative who experienced a bad side effect with a particular medication, that patient will likely not take that drug. Conversely, you can use the same phenomenon by telling them, “I had a patient who reminded me a lot of you. Their disease was so similar, and they did really well on...” and you name the drug. That single anecdote can be far more reassuring to patients than all of the numbers.

References

Bubak C, Schaarschmidt M-L, Schöben L, Peitsch WK, Schmieder A. Analyzing the value of an educational program for psoriasis patients: a prospective controlled pilot study. BMC Public Health. 2019;19(1):1535. doi:10.1186/s12889-019-7778-x

Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease - strategies for optimizing treatment outcome. J Eur Acad Dermatol Venereol. 2019;33(12):2253-2263. doi:10.1111/jdv.15913

Feldman SR, Vrijens B, Gieler U, Piaserico S, Puig L, van de Kerkhof P. Treatment adherence intervention studies in dermatology and guidance on how to support adherence. Am J Clin Dermatol. 2017;18(2):253-271. doi:10.1007/s40257-017-0253-5

Mocanu M, Toader M-P, Rezus E, Taranu T. Aspects concerning patient adherence to anti-TNFα therapy in psoriasis: a decade of clinical experience. Exp Ther Med. 2019;18(6):4987-4992. doi:10.3892/etm.2019.8008

Murage MJ, Anderson A, Casso D, et al. Treatment patterns, adherence, and persistence among psoriasis patients treated with biologics in a real-world setting, overall and by disease severity. J Dermatolog Treat. 2019;30(2):141-149. doi:10.1080/09546634.2018.1479725

Wang W, Qiu Y, Zhao F, Zhang F. Poor medication adherence in patients with psoriasis and a successful intervention. J Dermatolog Treat. 2019;30(6):525-528. doi:10.1080/09546634.2018.1476652

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