Physicians who discuss the cost of medications and offer a concrete, alternative plan may be able to improve primary adherence with prescribed acne medications among their patients, according to the results of a recent qualitative analysis conducted at a large academic health system in Philadelphia, Pennsylvania, and published in JAMA Dermatology.

The investigators sought to describe patient experiences with primary nonadherence to acne medications and to identify those physician-level factors that might help to improve adherence among this population. A total of 385 patients from 4 dermatology practices in Philadelphia were screened for primary nonadherence with a newly prescribed acne medication. Ultimately, 26 patients participated in structured interviews that were conducted from November 30, 2016, to January 31, 2017.

Among the study participants, 73% (19 of 26) were women. Overall, 23% (6 of 26) of the participants were <26 years of age, 58% (15 of 26) of them were 26 to 40 years of age, and 19% (5 of 26) of participants were >40 years of age.

Cost was reported to be the major barrier to initiating treatment. Although participants anticipated this barrier, they rarely discussed it with their physician during their initial consultation and usually did not expect their physician to be knowledgeable in this area. Despite experiencing inconvenience and frustration on being unable to fill their acne medication prescriptions, such situations did not seem to have a negative impact on patients’ satisfaction with their prescribing physician.


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Included among actions that physicians might take to improve primary adherence were warning patients that the preferred medication might be expensive, having a plan of action available if patients were unable to fill their prescriptions, and securing patients’ commitment to the treatment plan.

The investigators concluded that physician-level interventions designed to improve primary adherence with acne medications may have an impact on nonadherence with expensive medications, even though this might not affect an individual patient’s satisfaction with his or her prescribing physician.

Reference

Ryskina KL, Goldberg E, Lott B, Hermann D, Barbieri JS, Lipoff JB. The role of the physician in patient perceptions of barriers to primary adherence with acne medications [published online February 28, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.6144