Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
Division of General Internal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia.
JAMA Dermatol. 2018 Apr 1;154(4):456-459. doi: 10.1001/jamadermatol.2017.6144.
Primary nonadherence with acne medications is high but commonly underreported to prescribing physicians.
To describe patient experiences with primary nonadherence to medications for acne and to identify physician-level factors that may improve adherence in this population.
DESIGN, SETTING, AND PARTICIPANTS: A qualitative analysis was conducted from structured interviews with patients reporting nonadherence with acne medications at a large academic health system in the Philadelphia, Pennsylvania, area. Three hundred eighty-five patients from 4 dermatology practices in the Philadelphia area were screened for primary nonadherence with a newly prescribed acne medication. Twenty-six patients participated in structured interviews conducted between November 30, 2016, and January 31, 2017.
Thematic analysis of the transcripts was performed to detect recurrent themes and divergent ideas with a focus on modifiable physician-level factors that might improve primary adherence to medications for acne.
Participants (19 [73%] women, 6 [23%] aged <26 years, 15 [58%] aged 26-40 years, and 5 [19%] aged >40 years) reported cost as the major barrier to initiating therapy. Despite anticipating this barrier, they rarely brought up costs with physicians during the initial visit and generally did not expect their physician to be knowledgeable in this area. Although patients experienced inconvenience and frustration when unable to fill their prescriptions, this experience did not appear to negatively affect their satisfaction with the prescribing physician. Nevertheless, warning patients that the preferred medication may be expensive, having a plan of action if patients were unable to fill the prescription, and securing the patient's commitment to the plan were described as actions that the physicians could take to improve primary adherence.
Physician-level interventions to improve primary adherence to medications for acne may have an impact on nonadherence with costly medications, although they may not affect patient satisfaction with the prescribing physician.
初级不遵医嘱治疗痤疮的情况很高，但通常向开处方的医生报告的情况却很少。
描述患者在使用痤疮药物时初次不遵医嘱的经历，并确定可能改善该人群依从性的医生层面的因素。
设计、地点和参与者：在宾夕法尼亚州费城地区的一家大型学术医疗系统中，对报告初次不遵医嘱使用痤疮药物的患者进行了结构化访谈的定性分析。从费城地区的 4 个皮肤科诊所中筛选出 385 名初次不遵医嘱使用新处方痤疮药物的患者。2016 年 11 月 30 日至 2017 年 1 月 31 日期间，对 26 名患者进行了结构化访谈。
对转录本进行主题分析，以发现可重复出现的主题和不同的想法，重点关注可能改善痤疮药物初级依从性的可修改的医生层面的因素。
参与者（19 名[73%]为女性，6 名[23%]年龄<26 岁，15 名[58%]年龄 26-40 岁，5 名[19%]年龄>40 岁）报告说，费用是开始治疗的主要障碍。尽管他们预计会有这个障碍，但他们在初次就诊时很少向医生提及费用问题，通常也不期望医生在这方面有知识。尽管患者在无法开出处方时感到不便和沮丧，但这并没有影响他们对开处方医生的满意度。尽管如此，警告患者首选药物可能昂贵、如果患者无法开出处方时制定行动计划、并确保患者对计划的承诺被描述为可以改善初级依从性的医生层面的措施。
改善痤疮药物初级依从性的医生层面干预措施可能对昂贵药物的不依从性产生影响，尽管它们可能不会影响患者对开处方医生的满意度。
