Researchers Explore and Measure Patient Adherence to Therapies and Treatment Regimens in Dermatology

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A recent review published in the Journal of the European Academy of Dermatology and Venereology Clinical Practice explored the factors that contribute to patient adherence and non-adherence to therapies and treatment regimens in dermatology.¹

Researchers Lo et al described adherence not only as the behaviors and actions of patients and the ways they align with their providers' instructions and recommendations but also as the extent of such participation. They noted that poor adherence can be classified as either primary or secondary noncompliance, with the former representative of patients who have not collected or began the treatment, and the latter representing patients who discontinue treatment early or incorrectly follow the regimen.

Primary and secondary noncompliance is associated with the following:²

• Drug inefficacy
• Increased morbidity
• Increased mortality
• Poor clinical outcomes
• Reduced quality of life

Researchers conducted a search of MEDLINE using the search terms, "adherence," "dermatology," and "treatment" from 2006 to 2023. English papers comprising clinical trials, observational studies, and randomized controlled trials in human patients were considered for inclusion.

Studies were included in the review if they involved explorations of treatment adherence in dermatology, with compliance as a primary or secondary outcome.

Various methods of measuring treatment adherence exist, but there is no standardized approach, wrote Lo et al. Subjective methods like self-reports tend to overestimate adherence. Tools like ECOB and MMAS-8 help assess adherence, while others including QATOP and TTAQ identify factors for non-adherence. Objective methods such as electronic monitors and pharmacy refills are more accurate but can still have limitations. Direct measurements, both continuous and dichotomous, provide precise data, but dichotomous methods may lack sensitivity. An adherence rate above 80% is crucial for optimal outcomes.

Researchers identified several factors attributable to nonadherence. These included patient-centered factors, treatment-centered factors, and disease-centered factors. These factors may include socioeconomic status, patient demographics (age, gender, level of education), duration of treatment, frequency and amount of application, and more.

"Treatment adherence declines in the presence of barriers associated with lower socioeconomic status...Closely related to socioeconomic status, a higher degree of education is associated with increased adherence," according to Lo et al. "Young adults are more likely to intentionally and unintentionally avoid medication doses due to concerns about developing medication dependence. Furthermore, they may be less likely to take their medication if their symptoms are not as severe as those found in their older counterparts."

The vehicle of treatment used in a treatment regimen is also capable of impacting adherence. Lo et al note that easy to apply, non-greasy, and odor-free formulas are preferred by patients, and these preferences may influence treatment compliance.

Factors such as disease severity have negative impacts on adherence, with those with more severe skin disease more likely to be noncompliant with treatment regimens.

"Depending on the type, duration, severity, location and psychologic and social burden of skin diseases, adherence to dermatological treatments and recommendations can vary," they wrote. "Chronic skin conditions have substantially greater rates of primary and secondary non-adherence than acute skin disorders."

Physician-directed ways to increase treatment adherence among their patients include eHealth interventions, education, effective communication, simplified office visit scheduling, the simplification of more complex treatment routines, reducing adverse reactions, and engaging in psychological interventions if necessary.

Regarding specific dermatological conditions, in psoriasis, "Interventions that improved adherence also improved disease severity and patients' quality of life."¹ Likewise, greater adherence in patients with atopic dermatitis is associated with improvement of clinical symptoms and disease improvement. In acne, frequent methods of intervention could be associated with improved acne severity.

"With the aid of new, advanced technology and tools, we can now better measure adherence rates, develop interventions to increase adherence, and grasp the relationship between treatment adherence and efficacy in dermatology," according to Lo et al.

References

1. Lo A, Lovell KK, Greenzaid JD, Oscherwitz ME, Feldman SR. Adherence to treatment in dermatology: Literature review. J Eur Acad Dermatol Venereol Clin Pract. February 14, 2024. Accessed February 20, 2024. https://doi.org/10.1002/jvc2.379
2. Kim YY, Lee JS, Kang HJ, Park SM. Effect of medication adherence on long-term all-cause-mortality and hospitalization for cardiovascular disease in 65,067 newly diagnosed type 2 diabetes patients. Sci Rep. 2018; 8(1):12190. https://doi.org/10.1038/s41598-018-30740-y