American Journal of Clinical Dermatology

, Volume 18, Issue 2, pp 253–271 | Cite as

Treatment Adherence Intervention Studies in Dermatology and Guidance on How to Support Adherence

  • Steven R. Feldman
  • Bernard Vrijens
  • Uwe Gieler
  • Stefano Piaserico
  • Lluís Puig
  • Peter van de Kerkhof
Review Article

Abstract

Adequate adherence to prescribed treatment regimens can help to break the cycle of treatment failure, disease progression and subsequent treatment escalation. Unfortunately, adherence in the treatment of skin disorders such as acne, atopic dermatitis/eczema and psoriasis is often inadequate. A review of the literature identified a number of studies that tested an intervention to improve adherence in dermatology, including the following: electronic messages and/or reminders; more frequent or ‘extra’ clinic visits; audio-visual and internet-based interventions; and patient support programmes and/or self-management, educational training programmes. While there is no one solution or action for improving adherence, some interventions were more successful than others. We provide practical guidance on how to support adherence based on aspects of the successful interventions identified and on our collective opinion and clinical practice experience. Holding patients accountable, providing a caring and supportive environment, raising awareness of poor adherence and helping patients build a solid medication-taking habit can help to improve adherence so that patients can experience maximal treatment benefits and desired clinical outcomes.

Supplementary material

40257_2017_253_MOESM1_ESM.pdf (179 kb)
Supplementary material 1 (PDF 179 kb)

References

  1. 1.
    National Institute for Health and Clinical Excellence. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence CG76. 2009.Google Scholar
  2. 2.
    Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705. doi:10.1111/j.1365-2125.2012.04167.x.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Augustin M, Holland B, Dartsch D, Langenbruch A, Radtke MA. Adherence in the treatment of psoriasis: a systematic review. Dermatology. 2011;222(4):363–74. doi:10.1159/000329026.CrossRefPubMedGoogle Scholar
  4. 4.
    Lott R, Taylor SL, O’Neill JL, Krowchuk DP, Feldman SR. Medication adherence among acne patients: a review. J Cosmet Dermatol. 2010;9(2):160–6. doi:10.1111/j.1473-2165.2010.00490.x.CrossRefPubMedGoogle Scholar
  5. 5.
    Beattie PE, Lewis-Jones MS. Parental knowledge of topical therapies in the treatment of childhood atopic dermatitis. Clin Exper Dermatol. 2003;28(5):549–53.CrossRefGoogle Scholar
  6. 6.
    Krejci-Manwaring J, Tusa MG, Carroll C, Camacho F, Kaur M, Carr D, et al. Stealth monitoring of adherence to topical medication: adherence is very poor in children with atopic dermatitis. J Am Acad Dermatol. 2007;56(2):211–6. doi:10.1016/j.jaad.2006.05.073.CrossRefPubMedGoogle Scholar
  7. 7.
    Santer M, Burgess H, Yardley L, Ersser SJ, Lewis-Jones S, Muller I, et al. Managing childhood eczema: qualitative study exploring carers’ experiences of barriers and facilitators to treatment adherence. J Adv Nurs. 2013;69(11):2493–501. doi:10.1111/jan.12133.PubMedGoogle Scholar
  8. 8.
    Saeki H, Imafuku S, Abe M, Shintani Y, Onozuka D, Hagihara A, et al. Poor adherence to medication as assessed by the Morisky Medication Adherence Scale-8 and low satisfaction with treatment in 237 psoriasis patients. J Dermatol. 2015;42(4):367–72. doi:10.1111/1346-8138.12804.CrossRefPubMedGoogle Scholar
  9. 9.
    Furue M, Onozuka D, Takeuchi S, Murota H, Sugaya M, Masuda K, et al. Poor adherence to oral and topical medication in 3096 dermatological patients as assessed by the Morisky Medication Adherence Scale-8. Br J Dermatol. 2015;172(1):272–5. doi:10.1111/bjd.13377.CrossRefPubMedGoogle Scholar
  10. 10.
    Devaux S, Castela A, Archier E, Gallini A, Joly P, Misery L, et al. Adherence to topical treatment in psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol JEADV. 2012;26(Suppl 3):61–7. doi:10.1111/j.1468-3083.2012.04525.x.CrossRefPubMedGoogle Scholar
  11. 11.
    Dreno B, Thiboutot D, Gollnick H, Finlay AY, Layton A, Leyden JJ, et al. Large-scale worldwide observational study of adherence with acne therapy. Int J Dermatol. 2010;49(4):448–56. doi:10.1111/j.1365-4632.2010.04416.x.CrossRefPubMedGoogle Scholar
  12. 12.
    Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47(6):555–67.CrossRefPubMedGoogle Scholar
  13. 13.
    Stack RJ, Bundy C, Elliott RA, New JP, Gibson JM, Noyce PR. Patient perceptions of treatment and illness when prescribed multiple medicines for co-morbid type 2 diabetes. Diabetes Metab Syndr Obes Targets Ther. 2011;4:127–35. doi:10.2147/DMSO.S17444.CrossRefGoogle Scholar
  14. 14.
    Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013;8(12):e80633. doi:10.1371/journal.pone.0080633.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Horne R. Representations of medication and treatment: advances in theory and measurement. In: Petrie KJ, Weinman JA, editors. Perceptions of health and illness: current research and applications. London: Harwood Academic Press; 1997. p. 155–88.Google Scholar
  16. 16.
    Horne R. Treatment perception and self regulation. In: Camerson LD, Leventhal H, editors. The self-regulation of health and illness behaviour. London: Routledge; 2003. p. 138–53.Google Scholar
  17. 17.
    Lee IA, Maibach HI. Pharmionics in dermatology: a review of topical medication adherence. Am J Clin Dermatol. 2006;7(4):231–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Tan X, Feldman SR, Chang J, Balkrishnan R. Topical drug delivery systems in dermatology: a review of patient adherence issues. Expert Opin Drug Deliv. 2012;9(10):1263–71. doi:10.1517/17425247.2012.711756.CrossRefPubMedGoogle Scholar
  19. 19.
    Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol. 2013;4:91. doi:10.3389/fphar.2013.00091.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Assawasuwannakit P, Braund R, Duffull SB. Quantification of the forgiveness of drugs to imperfect adherence. CPT Pharmacomet Syst Pharmacol. 2015;4(3):e00004. doi:10.1002/psp4.4.CrossRefGoogle Scholar
  21. 21.
    Dusing R, Lottermoser K, Mengden T. Compliance with drug therapy-new answers to an old question. Nephrol Dial Transpl Off Publ Eur Dial Transpl Assoc Eur Renal Assoc. 2001;16(7):1317–21.Google Scholar
  22. 22.
    Carr A, Patel R, Jones M, Suleman A. A pilot study of a community pharmacist intervention to promote the effective use of emollients in childhood eczema. Pharm J. 2007;278:319–22.Google Scholar
  23. 23.
    Cork MJ, Britton J, Butler L, Young S, Murphy R, Keohane SG. Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse. Br J Dermatol. 2003;149(3):582–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Mollerup A, Veien NK, Johansen JD. Effectiveness of the Healthy Skin Clinic–a randomized clinical trial of nurse-led patient counselling in hand eczema. Contact Dermat. 2014;71(4):202–14. doi:10.1111/cod.12243.CrossRefGoogle Scholar
  25. 25.
    Moore EJ, Williams A, Manias E, Varigos G, Donath S. Eczema workshops reduce severity of childhood atopic eczema. Australas J Dermatol. 2009;50(2):100–6. doi:10.1111/j.1440-0960.2009.00515.x.CrossRefPubMedGoogle Scholar
  26. 26.
    Pena-Robichaux V, Kvedar JC, Watson AJ. Text messages as a reminder aid and educational tool in adults and adolescents with atopic dermatitis: a pilot study. Dermatol Res Pract. 2010;2010. doi:10.1155/2010/894258.
  27. 27.
    Staab D, von Rueden U, Kehrt R, Erhart M, Wenninger K, Kamtsiuris P, et al. Evaluation of a parental training program for the management of childhood atopic dermatitis. Pediatr Allergy Immunol Off Publ Eur Soc Pediatr Allergy Immunol. 2002;13(2):84–90.CrossRefGoogle Scholar
  28. 28.
    Yentzer BA, Camacho FT, Young T, Fountain JM, Clark AR, Feldman SR. Good adherence and early efficacy using desonide hydrogel for atopic dermatitis: results from a program addressing patient compliance. J Drugs Dermatology JDD. 2010;9(4):324–9.PubMedGoogle Scholar
  29. 29.
    Sagransky MJ, Yentzer BA, Williams LL, Clark AR, Taylor SL, Feldman SR. A randomized controlled pilot study of the effects of an extra office visit on adherence and outcomes in atopic dermatitis. Arch Dermatol. 2010;146(12):1428–30. doi:10.1001/archdermatol.2010.368.CrossRefPubMedGoogle Scholar
  30. 30.
    Boker A, Feetham HJ, Armstrong A, Purcell P, Jacobe H. Do automated text messages increase adherence to acne therapy? Results of a randomized, controlled trial. J Am Acad Dermatol. 2012;67(6):1136–42. doi:10.1016/j.jaad.2012.02.031.CrossRefPubMedGoogle Scholar
  31. 31.
    Eichenfield LF, Krakowski AC. A novel patient support program to address isotretinoin adherence: proof-of-concept analysis. J Drugs Dermatol JDD. 2015;14(4):375–9.PubMedGoogle Scholar
  32. 32.
    Fabbrocini G, Izzo R, Donnarumma M, Marasca C, Monfrecola G. Acne smart club: an educational program for patients with acne. Dermatology. 2014;229(2):136–40. doi:10.1159/000362809.CrossRefPubMedGoogle Scholar
  33. 33.
    Navarrete-Dechent C, Curi-Tuma M, Nicklas C, Cardenas C, Perez-Cotapos ML, Salomone C. Oral and written counseling is a useful instrument to improve short-term adherence to treatment in acne patients: a randomized controlled trial. Dermatol Pract Concept. 2015;5(4):13–6. doi:10.5826/dpc.0504a04.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Tuong W, Wang AS, Armstrong AW. Effect of automated online counseling on clinical outcomes and quality of life among adolescents with acne vulgaris: a randomized clinical trial. JAMA Dermatol. 2015;151(9):970–5. doi:10.1001/jamadermatol.2015.0859.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Yentzer BA, Gosnell AL, Clark AR, Pearce DJ, Balkrishnan R, Camacho FT, et al. A randomized controlled pilot study of strategies to increase adherence in teenagers with acne vulgaris. J Am Acad Dermatol. 2011;64(4):793–5. doi:10.1016/j.jaad.2010.05.008.CrossRefPubMedGoogle Scholar
  36. 36.
    Yentzer BA, Wood AA, Sagransky MJ, O’Neill JL, Clark AR, Williams LL, et al. An Internet-based survey and improvement of acne treatment outcomes. Arch Dermatol. 2011;147(10):1223–4. doi:10.1001/archdermatol.2011.277.CrossRefPubMedGoogle Scholar
  37. 37.
    Balato N, Megna M, Di Costanzo L, Balato A, Ayala F. Educational and motivational support service: a pilot study for mobile-phone-based interventions in patients with psoriasis. Br J Dermatol. 2013;168(1):201–5. doi:10.1111/j.1365-2133.2012.11205.x.CrossRefPubMedGoogle Scholar
  38. 38.
    de Korte J, Van Onselen J, Kownacki S, Sprangers MA, Bos JD. Quality of care in patients with psoriasis: an initial clinical study of an international disease management programme. J Eur Acad Dermatol Venereol JEADV. 2005;19(1):35–41. doi:10.1111/j.1468-3083.2004.01107.x.CrossRefPubMedGoogle Scholar
  39. 39.
    Armstrong AW, Watson AJ, Makredes M, Frangos JE, Kimball AB, Kvedar JC. Text-message reminders to improve sunscreen use: a randomized, controlled trial using electronic monitoring. Arch Dermatol. 2009;145(11):1230–6. doi:10.1001/archdermatol.2009.269.CrossRefPubMedGoogle Scholar
  40. 40.
    Armstrong AW, Idriss NZ, Kim RH. Effects of video-based, online education on behavioral and knowledge outcomes in sunscreen use: a randomized controlled trial. Patient Educ Couns. 2011;83(2):273–7. doi:10.1016/j.pec.2010.04.033.CrossRefPubMedGoogle Scholar
  41. 41.
    Tuong W, Armstrong AW. Effect of appearance-based education compared with health-based education on sunscreen use and knowledge: a randomized controlled trial. J Am Acad Dermatol. 2014;70(4):665–9. doi:10.1016/j.jaad.2013.12.007.CrossRefPubMedGoogle Scholar
  42. 42.
    Szabó C, Ocsai H, Csabai M, Kemeny L. A randomised trial to demonstrate the effectiveness of electronic messages on sun protection behaviours. J Photochem Photobiol B. 2015;149:257–64. doi:10.1016/j.jphotobiol.2015.06.006.CrossRefPubMedGoogle Scholar
  43. 43.
    Alili ME, Vrijens B, Demonceau J, Evers SM, Hiligsmann M. A scoping review of studies comparing the Medication Event Monitoring System (MEMS) with alternative methods for measuring medication adherence. Br J Clin Pharmacol. 2016;82(1):268–79. doi:10.1111/bcp.12942.CrossRefPubMedGoogle Scholar
  44. 44.
    Greenlaw SM, Yentzer BA, O’Neill JL, Balkrishnan R, Feldman SR. Assessing adherence to dermatology treatments: a review of self-report and electronic measures. Skin Res Technol Off J Int Soc Bioeng Skin. 2010;16(2):253–8. doi:10.1111/j.1600-0846.2010.00431.x.CrossRefGoogle Scholar
  45. 45.
    Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.CrossRefPubMedGoogle Scholar
  46. 46.
    Fialko L, Garety PA, Kuipers E, Dunn G, Bebbington PE, Fowler D, et al. A large-scale validation study of the Medication Adherence Rating Scale (MARS). Schizophr Res. 2008;100(1–3):53–9. doi:10.1016/j.schres.2007.10.029.CrossRefPubMedGoogle Scholar
  47. 47.
    Geller AC, Shamban J, O’Riordan DL, Slygh C, Kinney JP, Rosenberg S. Raising sun protection and early detection awareness among Florida high schoolers. Pediatr Dermatol. 2005;22(2):112–8. doi:10.1111/j.1525-1470.2005.22204.x.CrossRefPubMedGoogle Scholar
  48. 48.
    Cercato MC, Nagore E, Ramazzotti V, Sperduti I, Guillen C. Improving sun-safe knowledge, attitude and behaviour in parents of primary school children: a pilot study. J Cancer Educ Off J Am Assoc Cancer Educ. 2013;28(1):151–7. doi:10.1007/s13187-012-0413-5.CrossRefGoogle Scholar
  49. 49.
    Feinstein AR. On white-coat effects and the electronic monitoring of compliance. Arch Intern Med. 1990;150(7):1377–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Benarous X, Legrand C, Consoli SM. Motivational interviewing use for promoting health behavior: an approach of doctor/patient relationship. La Revue de Medecine Interne. 2014;35(5):317–21. doi:10.1016/j.revmed.2013.08.009.CrossRefPubMedGoogle Scholar
  51. 51.
    Gorawara-Bhat R, Gallagher TH, Levinson W. Patient-provider discussions about conflicts of interest in managed care: physicians’ perceptions. Am J Manag Care. 2003;9(8):564–71.PubMedGoogle Scholar
  52. 52.
    Molassiotis A, Morris K, Trueman I. The importance of the patient-clinician relationship in adherence to antiretroviral medication. Int J Nurs Pract. 2007;13(6):370–6. doi:10.1111/j.1440-172X.2007.00652.x.CrossRefPubMedGoogle Scholar
  53. 53.
    van Netten JJ, Francis A, Morphet A, Fortington LV, Postema K, Williams A. Communication techniques for improved acceptance and adherence with therapeutic footwear. Prosthet Orthot Int. 2016;. doi:10.1177/0309364616650080.PubMedGoogle Scholar
  54. 54.
    Johnson A, Sandford J. Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home: systematic review. Health Educ Res. 2005;20(4):423–9. doi:10.1093/her/cyg141.CrossRefPubMedGoogle Scholar
  55. 55.
    Johnson A, Sandford J, Tyndall J. Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Database Syst Rev. 2003;4:CD003716. doi:10.1002/14651858.CD003716.Google Scholar
  56. 56.
    Kaskutas LA. Alcoholics anonymous effectiveness: faith meets science. J Addict Dis. 2009;28(2):145–57. doi:10.1080/10550880902772464.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Demonceau J, Ruppar T, Kristanto P, Hughes DA, Fargher E, Kardas P, et al. Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: a systematic literature review and meta-analysis. Drugs. 2013;73(6):545–62. doi:10.1007/s40265-013-0041-3.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Vrijens B, Belmans A, Matthys K, de Klerk E, Lesaffre E. Effect of intervention through a pharmaceutical care program on patient adherence with prescribed once-daily atorvastatin. Pharmacoepidemiol Drug Saf. 2006;15(2):115–21. doi:10.1002/pds.1198.CrossRefPubMedGoogle Scholar
  59. 59.
    Vrijens B, Urquhart J, White D. Electronically monitored dosing histories can be used to develop a medication-taking habit and manage patient adherence. Expert Rev Clin Pharmacol. 2014;7(5):633–44. doi:10.1586/17512433.2014.940896.CrossRefPubMedGoogle Scholar
  60. 60.
    Duhigg C. The power of habit: why we do what we do in life and business. New York: Random House Inc; 2012.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Steven R. Feldman
    • 1
  • Bernard Vrijens
    • 2
    • 3
  • Uwe Gieler
    • 4
  • Stefano Piaserico
    • 5
  • Lluís Puig
    • 6
  • Peter van de Kerkhof
    • 7
  1. 1.Wake Forest School of MedicineWinston-SalemUSA
  2. 2.WestRock HealthcareViséBelgium
  3. 3.University of LiègeLiègeBelgium
  4. 4.Justus Liebig UniversityGiessenGermany
  5. 5.University of PaduaPaduaItaly
  6. 6.Hospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
  7. 7.Radboud University Nijmegen Medical CentreNijmegenThe Netherlands

Personalised recommendations