How to improve prescription adherence

Lack of patient adherence to prescribed therapies remains a central issue in dermatology and, according to one expert, a multifaceted strategy can improve compliance, leading to improved treatment outcomes.

“Mastering the ‘perfect’ consultation is key in helping patients stick to prescribed treatment regimens. Above and beyond the requisite doctor-patient relationship, it is crucial that the goals of therapy are identified early in the consultation,” says Dr. Ravi Ratnavel, a consultant dermatologist at the Buckinghamshire Hospitals NHS Trust, United Kingdom.

According to Dr. Ratnavel, establishing the goals of therapy early on with the patient will likely lead to success in their adherence to the recommended treatments. For instance, it should be made clear to patients with psoriasis that the goal of treatment is to reduce the scaling and erythema and not the permanent clearance of the disease. Similarly, patients with eczema should know that the goal of therapy is not to cure the condition but instead to reduce inflammation and control itch so that they can have a better night’s sleep and improved quality of life.

The “perfect” consultation consists of five essential parts, Dr. Ratnavel says, and here, he implements his AIDES strategy, an acronym for:

• Assess medications

• Individualize treatment

• Documentation

• Education

• Supervision

According to Dr. Ratnavel, assessing a patient’s medications is particularly important in dermatology because it gives some insight into other potential problems that might influence the patient’s ability to carry out treatment.

Individualizing treatment is also important, as not all patients are amenable to all treatment regimens. Here, the choice of formulation is crucial Dr. Ratnavel said, and though a once daily treatment is usually an ideal approach, combination therapies can also be useful and can lead to treatment success.

“Documentation in terms of giving written instructions to the patient on how and when to use the medication can be instrumental in improving adherence and adds transparency to the process,” Dr. Ratnavel says. “Moreover, it is the responsibility of the physician to educate the patient in terms of what they can initially expect from a given treatment such as local inflammation, erythema, drying and scaling. If the patient is informed about what to expect, they may not stop treatment prematurely.”

Lastly, ongoing supervision and support from the physician and nursing staff can help keep patients on their medications, Dr. Ratnavel says. The use of patient-friendly digital technology such as written diaries in the form of emails as well as Skype can be helpful in supporting and monitoring patients and their treatment outcomes.