Feldman discusses improving adherence to treatment
NEW YORK – At the interdisciplinary Autoimmune Summit, Steven R. Feldman, MD, PhD, a dermatologist at Wake Forest University Hospital in Winston-Salem, N.C., discussed strategies to improve adherence to medications and how his team has studied the issues of compliance to medication dosing and schedules.
Feldman said that in a number of the studies with which he has been involved, patients were blinded to electronic devices places inside either medication bottles or injection disposal units to monitor actual compliance and compare the electronic signatures with patient diaries. While some patients were very compliant, many others over-reported their use of medications compared to the electronic record.
“Why aren’t patients compliant?” Feldman asked. He said in the case of dermatology, sometimes the medications are greasy or uncomfortable, but in other cases, when he has asked patients about their use, the time involved in application is much longer than expected. “They may be spending 2 hours applying these medications.”
Side effects or lack of immediate efficacy, Feldman said, are other reasons for lack of compliance.
Feldman said physicians can encourage better compliance by establishing relationships with patients, involving the patient in their own care, choosing fast-acting agents and schedule return visits.
Feldman said studies have shown that medication adherence is highest when patients are scheduled for a return visit, and likened the effect to a child’s piano instructor.
“You wouldn’t say to the child, ‘Here is your sheet music. The recital is in 8 to 12 weeks, so practice and I’ll see you then,’” highlighting the point that regular visits improve performance and adherence to good practicing habits.
Feldman said showing concern for the patients’ well-being is also important and encourages adherence, and suggesting strategies for patients to be reminded to use medication can also be helpful. Positive language, rather than playing into patient fears may also improve compliance. – by Shirley Pulawski
Feldman SR. Presented at: Interdisciplinary Autoimmune Summit 2016. April 1 – 3. New York City.
Disclosure: Feldman reports no relevant financial disclosures.