Quality time with patients improves adherence to medications

New York - Patient compliance to suggested therapy, whether topic or oral, remains the major obstacle in achieving good treatment outcomes in dermatology. Establishing trust with the patient, choosing a treatment plan that the patient likes, and scheduling the follow-up visit soon after first presentation are all key steps the physician can take in helping to improve patient compliance and further, treatment outcomes.

According to one expert, there are three major hurdles in getting patients well in the field of dermatology - and making the right diagnosis and prescribing the right therapy are not among the hurdles.

“We as dermatologists know what we are doing, in that we usually recognize the disease as soon as we walk in the room, and we are not prescribing the wrong medications in our patients,” says Steven R. Feldman, M.D., Ph.D., professor of dermatology, pathology, and public health sciences, and director of the Center for Dermatology Research at Wake Forest University School of Medicine, Winston-Salem, N.C. “The three hurdles in getting patients well are poor compliance, poor compliance and poor compliance.”

Adherence issues

Whether psoriasis, atopic dermatitis, acne or any of the commonly seen dermatologic diseases and conditions, Dr. Feldman says that more often than not, the main reason why patients do not improve in their symptoms is because they simply do not adhere to the therapeutic regimens as suggested by their physician.

“The adherence issues in dermatology are probably a lot bigger than they are in other fields of medicine,” he says. “That’s not to say that they are not big in other fields, but they are even bigger in dermatology because the basis of the vast majority of dermatologic therapies are topical, and therefore, much harder to comply with when compared to oral therapies.”

Topical dermatologic therapies typically may last for weeks to even months, or longer. It can be challenging for patients to maintain compliance with topicals for extended periods of time, regardless of the condition or disease for which patients are being treated.

“It’s relatively easy to take a pill and patients won’t likely forget to take their medicine every day, especially with the help of a seven-day pill box. However, if you’re treating foot fungus and you are at the breakfast table and you already put your shoes and socks on, you very likely will not put the cream on that day,” Dr. Feldman says.

Aside from patients being forgetful and having concerns over cost, Dr. Feldman says another reason why patients may not take their medications is because of a fear of potential side effects. This is particularly true for corticosteroids, whether topical or oral.

Establishing trust

Establishing a meaningful and close doctor-patient relationship is essential in gaining the patients’ trust, Dr. Feldman says, and it is the first crucial step in getting patients to take their medicine as prescribed. Establishing trust does not necessarily require more time with patients, he says, but instead, it requires spending more quality time with patients, which can include giving them a sense of calm by walking slowly into the examination room, laying hands on the lesion(s), and speaking softly and caringly with them.

“Your initial presentation and how you psychologically handle the patient in the first few minutes you spend with them is crucial in building that bridge of trust,” Dr. Feldman says.

“Patients are not going to trust the drug company, and they are not going to trust the drug,” he says, and therefore it is essential that they trust the doctor. According to Dr. Feldman, it is absolutely essential to establish that connection with the patient and give them the feeling that you understand what they are going through and truly care, even though you have already mentally decided on how you are going to treat them as soon as you walked in the room.

“If you make sure that they realize you care about them, then they will trust you and follow your instructions in order to please you. If they think you don’t care about them, then they very likely are not going to take the medicine,” Dr. Feldman said.

Next steps

After suggesting a given therapy, the next step is to get patients to fill their prescription and use the medicine. According to Dr. Feldman, this can be best achieved by asking to see them back in a week for a follow-up visit, instead of four or eight weeks later.

“Seeing patients after one week will force them to fill their prescription right away. They will begin to use the medicine throughout that first week, right before their second visit, which will invariably bring good therapeutic results and will fuel them to take the medicine long-term,” he says.

In more difficult patients and cases such as recalcitrant psoriasis, Dr. Feldman says he will often write down his cell phone number and hand it to the patient prior to leaving the exam room, asking them to call in three days and report on their progress. In the vast majority of cases, Dr. Feldman says patients never misused the phone number, and they usually leave a message reporting excellent results because they were quick to fill their prescription and take the medicine as prescribed.

“Patient psychology is a major part of practicing good, effective, and efficient dermatology. Giving patients your personal cell phone number can help establish a very close trust, as it gives patients the feeling that they are special, taken care of, and understood,” he says. “It’s not difficult to make the diagnosis of psoriasis and prescribe appropriate therapy. What makes dermatology fun and exciting is figuring out how to get patients to use their medications.”

Disclosures: Dr. Feldman reports no relevant financial interests.

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