Do People Stick With a Long-Term Treatment Regimen?
Psoriasis can be treated well with topical medications, however, staying with the regimen is key to success. Studies have shown that adherence to a short-term topical regimen is poor, but given that psoriasis his a chronic disease, researchers wondered whether long-term adherence has the same problem. In addition, studies that have established the low adherence mostly used self-reported measures, which can be unreliable.
A recently published study looked at both adherence to long-term treatment with topical fluocinonide and used the study to assess the potential of an internet-based reporting intervention to improve treatment adherence and outcomes. Forty patients with mild-to-moderate psoriasis were randomized into two groups: one received standard-of-care and the other reported their impression of the state of their psoriasis over the internet on a weekly basis. Both groups also used Medication Event Monitoring System (MEMS) caps, which are electronic monitors affixed to the medication containers. Patients were not told of the electronic monitoring system until the study was completed.
Half of the original 40 patients dropped out of the study due to various reasons such as worsening disease, finding a better education, or disliking the study medication. Of the 20 remaining subjects, 100% did not take the medication as directed. The recommended dose was only taken on 15% of the observed study days. Most patients in the standard-of-care group did not apply treatment at all. The intervention group had better adherence, but the effects did not last throughout the length of the study.
Overall, the intervention group used 50% of the prescribed number of doses and the percentage of days with correct dosing was 14% higher in the intervention group, though was still a relatively low 34%. Patients in the internet survey group had higher adherence in first month of the study and had numerically higher adherence until month 10 of the study. Adherence in both groups declined over time.
These data suggest that almost no one used the medication well enough to find out how effective it could be, particularly in the standard-of-care group. The authors state that the findings highlight the need for providers to go beyond diagnosis and prescribing and interventions that improve use of the recommended treatment are critically important.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: April 18, 2017
Source: Wiley Online Library
Adapted from the original article.