Improving Treatment Adherence in Atopic Dermatitis

Management of atopic dermatitis has improved dramatically over the last few years, thanks to better understanding of this chronic inflammatory skin disease as well as more effective therapies. In spite of this, however, poor adherence to treatment remains a barrier to optimal control.

In this MedPage Today video, Steven Feldman, MD, PhD, professor of dermatology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, describes what physicians can do to achieve better adherence.

Following is a transcript of his remarks:

What can doctors do? Well, we’ve got great treatments for people. The key thing is getting them to use them. So establishing a relationship where there’s trust in the physician, I think is critical. I’ve seen some suggestions that people want to see, and are more comfortable seeing, a doctor that they can relate to. And therefore, perhaps diversity in the workforce could be as important as some of the other factors. Which would mean diversity in the training programs, diversity in what it takes to get access to a dermatology training program.

But the bottom line is if somebody’s got atopic dermatitis, we’ve got treatments; they’ll clear it right up. So if you establish that foundation of trust, and when you prescribe a new treatment, hold patients accountable to using it, they should get better.

And by accountability, well, let me tell you what I think is not accountable care. When you tell patients, here, do this; I’ll see you back in 2 to 3 months. If a piano teacher said, here’s your sheet music, see you in 2 to 3 months at the recital, that recital is going to sound horrible. People don’t practice unless you have those weekly piano lessons.

And so when I start a patient with atopic dermatitis on any new treatment, I’m going to give them my cell phone number, tell them to call me later in the week to let me know how it’s working.

I think that not only builds that sense of trust in me, because they realize how much I care about them, but in addition, it sort of forces them to fill the prescription right away and use it really well initially.

Then they see how well the treatment works — for example, a topical generic corticosteroid like triamcinolone. And the eczema just melts away and they may or may not call in 3 days, and if they do, I may or may not answer the phone. If I don’t, they leave me a message: “Oh, Dr. Feldman, I’m so glad you didn’t pick up the phone. I really didn’t want to bother you, but you said I had to call. This medicine’s working like a miracle.”

The miracle of good adherence to our treatment really makes a difference for patients.

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