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Physician–Patient Interaction and Communication Impact Adherence to Biologic Treatment in Patients With Psoriasis
TAKE-HOME MESSAGE
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This questionnaire-based, multicenter study in Germany analyzed potential predictors of adherence to biologic therapies by patients with moderate to severe psoriasis. Factors that were positively associated with adherence included prior failed treatments, awareness of comorbidities associated with severe psoriasis, and a positive personal interaction between the dermatologist and the patient. Nonadherence was observed more in patients with whom the physician found communication to be difficult.
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Effective patient education and positive physician–patient interactions can play key roles in influencing patient adherence and treatment outcomes in biologic therapies for moderate to severe psoriasis.
– InYoung Kim, MD, PhD
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Treatment efficacy of biologic agents in moderate to severe psoriasis is regarded as high with patient adherence being higher than for traditional therapies. However, use of biologics is connected to high discontinuation rates. The current investigator-initiated study was conducted to improve the understanding of adherence.
MATERIALS AND METHODS
The study was designed as non-interventional retrospective multicentre trial in Germany. Questionnaires were developed based on the adherence dimensions identified by the World Health Organization, WHO. Thirteen dermatologists and 246 patients participated in the study and replied to the questionnaires. Study data were analysed for potential predictors of adherence in an explorative manner.
RESULTS
Based on the physician's assessment of the patients' individual adherence, subsets of adherent and non-adherent patients were discriminated. Two main drivers were identified on the patients' side that were positively connected to adherence: a lack of efficacy of the previous treatments and the knowledge of comorbidities associated with severe psoriasis. Furthermore, physician-patient communication seems to play a central role, as on the dermatologists' side, there was a strong association of adherence and positive personal interrelation between dermatologist and patient.
CONCLUSION
The data reported here underline the importance of patient education and information delivery to optimize patient adherence and thereby treatment outcomes. Treating physicians should be aware that soft aspects of their interaction with the patient might influence treatment adherence.
Additional Info
Disclosure statements are available on the authors' profiles:
Evaluation of Adherence Predictors for the Treatment of Moderate to Severe Psoriasis With Biologics: The Importance of Physician-Patient Interaction and Communication
J Eur Acad Dermatol Venereol 2017 Apr 10;[EPub Ahead of Print], I Zschocke, C Ortland, K ReichFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Dermatologists are from Mars; Patients are from Venus
While adherence is generally a problem with topical treatment of common skin conditions, patients with horrible psoriasis given a highly effective (not to mention costly) biologic treatment can be counted on to take their medications exactly as prescribed, right? No! Patients often do not use treatments as recommended. Even biologic medication use for severe skin disease declines over time.
Zschocke et al evaluated adherence to biologics for psoriasis. The study has obvious limitations. The investigators didn’t have a great measure of adherence. Their survey was very long, and nonadherent patients often didn’t complete their surveys. Still, the findings are interesting and enlightening. The investigators asked dermatologists and patients about adherence and factors that affect whether the patients take their prescribed medications. When asked to describe the most important aspects of physician–patient communication, doctors reported content issues while patients reported wanting time and sympathy (Table 1).
Table 1. Physician and Patient Assessments of Important Aspects of Physician–Patient Communication
Perhaps the most notable finding in this study relates to the physicians’ perceptions of their patients. For adherent patients, over 60% of doctors strongly agreed with the statements “I am looking forward to the next visit of this patient,” “I have a good relationship with this patient,” and “You find the patient to be pleasant.” Fewer than 20% of the doctors strongly agreed with these same statements regarding nonadherent patients.
Having a trusting relationship is a foundation for good adherence. Zschocke et al state this eloquently and explicitly: “On the dermatologists’ side, the strongest predictors for adherence are soft and empathic aspects of physician–patient interaction, namely looking forward to the next visit of the patient, having a good relationship to the patent, and finding the patient pleasant.”
Many doctors seem to be like me. We focus on making the right diagnosis, prescribing the correct treatment, and sharing essential information; then we quickly move on to the next patient. (This is not surprising in my case since I got into medical school and into a dermatology residency because I do well on standardized tests, not because of good interpersonal skills). Patients, however, want time, sympathy, and, I believe above all else, a sense that their doctor cares about them.