How do disease perception, treatment features, and dermatologist–patient relationship impact on patients assuming topical treatment? An Italian survey

Abstract

BackgroundPsoriasis largely affects daily activities and social interactions and has a strong impact on patients’ quality of life. Psoriatic patients have different attitudes toward their condition. Topical medications are essential for the treatment of psoriasis, but the majority of patients do not adhere to these therapies.ObjectiveThe history of treatment success or failure seems to influence patient attitude toward topical therapy. Therefore, it is important to understand the psychological, experiential, and motivational aspects that could be critical for treatment adherence, and to describe the different attitudes toward topical treatment. Furthermore, the physician–patient relationship and the willingness to trust the dermatologist may have a substantial role in encouraging or discouraging patients’ attitudes toward topical therapy.MethodsA survey was designed to collect aspects that could be relevant to understanding different patient attitudes toward psoriasis and its treatments. A total of 495 self-administered questionnaires compiled by psoriatic patients were analyzed from 20 Italian specialized hospital centers in order to provide a nationwide picture.ResultsPsoriatic patients have different perceptions and experiences in relation to their condition: half of them consider psoriasis as a disease, while the other half consider psoriasis as a disorder or a nuisance. Topical therapy is the most widely used treatment, even though it is not considered the most effective one and often perceived to be cosmetic. The main findings are: 1) inadequate patient education about this disease, 2) lack of information about topical treatment, and 3) lack of results within the expected time frame. Furthermore, physicians need to build a good relationship with psoriatic patients in order to motivate them, to trust in their care, and to adhere to treatment.ConclusionThis survey adds new and important details about daily life and well-being and the needs of psoriatic patients, providing suggestions for dermatologists to improve patients management.

Psoriasis patients’ experiences concerning medical adherence to treatment with topical corticosteroids

“… 3 Considering treatment factors, adherence was limited when patients experienced the treatment as greasy, 5 but improved when treatment was easy to apply. 5 , 11 In relation to the health care system, adherence was limited when patients experienced uncertainty regarding the rationale behind the treatment plan, 6 , 7 , 12 but improved from confidence in the prescriber. 6 In relation to the disease, adherence was limited by having areas difficult to reach, 6 but improved when suffering from widespread disease.…”

“…5 , 11 In relation to the health care system, adherence was limited when patients experienced uncertainty regarding the rationale behind the treatment plan, 6 , 7 , 12 but improved from confidence in the prescriber. 6 In relation to the disease, adherence was limited by having areas difficult to reach, 6 but improved when suffering from widespread disease. 6 In relation to the patients themselves, adherence was limited by patients terminating treatment when initial positive treatment results were reached, 5 but improved by establishing routines in their everyday life.…”

“… 6 In relation to the disease, adherence was limited by having areas difficult to reach, 6 but improved when suffering from widespread disease. 6 In relation to the patients themselves, adherence was limited by patients terminating treatment when initial positive treatment results were reached, 5 but improved by establishing routines in their everyday life. 5 , 12 In addition to previous research, this study showed that the patients received help from their partner in checking the skin for flare-ups and assisting in greasing.…”

“… 2 In patients with psoriasis, the rate of medical nonadherence to topically prescribed corticosteroids or corticosteroid combinations is reported to range from 8% to 88%, 3 , 4 addressed in studies using heterogeneous study designs. The multifactorial determinants of medical nonadherence to topical corticosteroids and corticosteroid/calcipotriol combinations have mainly been investigated in survey studies, 5 , 6 while only briefly described in qualitative studies. 7 , 8 This led us to conduct this study, to get the patients’ own experiences and explanations on medical adherence.…”

Can an app supporting psoriasis patients improve adherence to topical treatment? A single-blind randomized controlled trial

“…Twelve original studies addressing adherence to topical corticosteroid treatments have been published consisting of 5 questionnaire surveys [ 10 – 14 ], 2 prospective studies [ 15 , 16 ], 1 qualitative study [ 17 ], 1 mixed-method study [ 18 ], 1 register study [ 19 ], and 2 intervention studies [ 20 , 21 ]. The observation periods varied with up to a year’s follow-up time.…”