Poor treatment persistence reported for new acne patients

Persistence with treatments was poor in a cohort of individuals newly diagnosed with acne, according to study findings.

Study author Steven R. Feldman, MD, PhD, professor of dermatology, pathology and social sciences and health policy at Wake Forest School of Medicine, explained to Healio why the group chose to study newly diagnosed patients.

“By studying patients when they start treatment, we can get a picture of both initial adherence and what happens over time,” Feldman said. “If we had looked at people late in the course of treatment, there would be a strong bias toward studying people who were highly adherent, as the less adherent ones would have likely already dropped out and would not be counted.”

The researchers noted that there are few data on how new patients adhere to acne medications. They also defined two important terms for the study.

“Adherence refers to patients obtaining treatment and acting in accordance with a prescribed interval and dose; persistence is the duration of time patients continue on treatment,” the researchers wrote.

The analysis included data for 230,552 patients aged 12 years or older who had been culled from the Truven Health MarketScan Databases. Claims for patients who filled an index prescription between 2008 and 2011 were included.

Results showed that medication possession ratio was 0.8 or higher in 70.3% of patients at 12 months. However, persistence of medication was 1.85% at the same time point.

Feldman addressed why adherence was so low in this patient cohort.

“As doctors, we tend to think that when we write a prescription, patients will, by default, use the medicine unless there is a problem,” he said. “We should be thinking that, by default, people will not do something new unless there are strong incentives and structures put into place to help assure that they do the new activity.”

Digging deeper, Feldman offered the analogy of a child taking piano lessons.

“In medical practice, doctors are like a piano teacher who says, ‘Here is a prescription for some sheet music. Take it to the music store and fill the prescription. I have no idea how much it will cost or whether your insurance will pay for it or not, or, for that matter, how much paperwork you'll have to do to get reimbursed by the insurer. But fill the prescription,’” he said.

He then added that his prescription may cause rashes, diarrhea or possibly a serious infection.

“But practice every day,” he said. “I will see you at the recital in 8 to 12 weeks. If the recital does not sound good, which is often the case, I will give you a second musical instrument to practice at the same time.”

In short, Feldman believes that patients are often left feeling dissatisfied with the treatments they have been prescribed.

“It is a miracle anyone is taking their medication regularly,” he said.

It is for this reason that Feldman believes that making the right diagnosis and prescribing the right treatment is two-thirds of what dermatologists need to be doing.

“The other third is getting patients to take the treatment,” he said.

However, he stressed that if a treatment is not working for a patient, making the regimen more complicated is not an optimal solution.

“We need to focus on getting patients to use their treatments well,” he said. “Giving them a treatment that fits their needs — for example, a combination treatment to make the treatment simpler, an antibiotic that reduces inflammation without upsetting the normal flora, etc — may be very helpful. Putting some thought into what helps people use the medicine and not rely on the assumption that they will do it without our help may be more important than developing new medicines.”