Improving psoriasis patients’ adherence to topical drugs: a systematic review

Svendsen, Mathias Tiedemann; Feldman, Steven R.; Tiedemann, Sylvia Naiga; Sørensen, Anne Sofie Stochholm; Rivas, Cecilie Marie Ringgaard; Andersen, Klaus Ejner

doi:10.1080/09546634.2019.1623371

Cited by 18 publications

(21 citation statements)

References 38 publications

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“…Since dermatologists are a limited resource, the use of dermatology nurses, who are trained to support psoriasis patients in their use of topical drugs, may be a practical solution for improved health outcomes, which can be measured by an objective reduction in the severity of skin disease and may also be reported by patients in patient-reported outcomes (PROs) (in regard to overall health-related quality of life and dermatology-specific quality of life) [ 12 ]. This is supported by clinical trials and focus group studies suggesting that improved support benefits adherence to topical drugs [ 13 – 15 ]. Improved support from dermatology nurses, with specialist training in supporting psoriasis patients may include [ 1 ] individualizing treatment plans, [ 2 ] providing easy access to dermatology consultation in case of flare-up, and [ 3 ] motivating patients to use the medication.…”

Section: Introductionmentioning

confidence: 84%

Long-term improvement of psoriasis patients’ adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals

Svendsen

Feldman

Möller

et al. 2021

Trials

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Background Psoriasis affects 2–4% of the Western adult population and is a socio-economic burden for patients and society. Topical drugs are recommended as first-line treatment for mild-to-moderate psoriasis, but low adherence is a barrier to treatment success. Psoriasis patients require support, in order to improve their long-term use of topical drugs. The project aims to test whether a patient-supporting intervention delivered by dermatology nurses can reduce the severity of psoriasis, improve the use of topical drugs, and is cost-effective compared to standard procedure. Methods The intervention consists of improved support delivered to patients by three experienced dermatology nurses, who will support patients on a regular basis by consultations with a focus on providing reminder systems, accountability, reinforcement, and building trust in the treatment. Each patient will be supported by the same dermatology nurse throughout the entire study period. The effect will be compared with standard procedure. The intervention will be tested in a randomized controlled trial during a 48-week period. A group of patients with moderate-to-severe psoriasis (psoriasis affecting ≥ 4% of the total body surface area) and 18–85 years of age who are prescribed topical treatment will be randomized to a non-intervention (n ≈ 57) or intervention group (n ≈ 57). Participants in both arms will be prescribed topical preparations containing corticosteroid and/or calcipotriol. The primary outcome will be a change in the severity of psoriasis, measured as reduction in the Lattice-System Physician’s Global Assessment. Secondary outcomes will include changes in health-related quality of life (measured by disease specific and generic questionnaires), primary adherence (i.e., proportion of filled prescriptions), and secondary adherence by objective measure (rate of topical drug consumption (obtained by weighing medication packages) compared to estimated recommended consumption). A health economic evaluation is planned to run alongside the trial. Participants’ total health costs will be estimated on the basis of health costs reported to the national health registries and costs spent on the intervention, after which a cost-utility and cost-effectiveness analysis will be carried out. Discussion If the intervention can reduce the severity of psoriasis in a significant manner and is economically favorable compared to standard treatment, there is potential for implementing the intervention in dermatology clinics. Trial registration Clinicaltrials.govNCT04220554. Registered on January 7, 2020. Study results, either positive, negative, or inconclusive, will be published on www.clinicaltrials.gov. Trial registration no. with the Danish Regional Committee on Health Research Ethics, registration no. 72613.

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Section: Introductionmentioning

confidence: 84%

Long-term improvement of psoriasis patients’ adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals

Svendsen

Feldman

Möller

et al. 2021

Trials

Self Cite

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“… 12 In addition, physical contact between patients and doctors may be reduced without considering the value and understanding of this physical contact. 23 All studies had a medium-low risk of bias.…”

Section: Discussionmentioning

confidence: 99%

Pros and cons of eHealth: A systematic review of the literature and observations in Denmark

2021

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Objectives: The main objectives of this article are to systematically review the recent literature on patient safety in relation to the use of eHealth and to investigate how the Danish authorities supervise private eHealth clinics with regard to patient safety. Methods: Original studies reporting the association between patient safety and the use of eHealth as a means of communication between patients and healthcare providers were included. Four literature databases were searched for English-language articles reporting results from cohort studies and clinical trials, published from 2015 until March 2021. Moreover, registered private eHealth clinics in Denmark were evaluated with reference to a recent national audit of patient safety issues in eHealth. Results: The literature search retrieved four intervention studies. The studies did not identify any particular patient safety risks associated with the use of eHealth. Many different authorized healthcare providers (preferably, doctors) apply eHealth in various contexts. eHealth is being used as the only form of contact between the healthcare provider and the patient, as a supplement to patient visitations in an outpatient clinic, or as a tool for communicating between two or more healthcare providers. The regulation of eHealth involves patient safety issues but also has interfaces to marketing, IT systems, and infrastructure. Supervision of eHealth includes the organization of clinics, handling patient charts, prescription medicine, patient legal rights, and patient transition. However, there are many interfaces in the division of responsibilities among the various governmental players. Conclusion: eHealth is being used increasingly and in many settings, although recently published intervention studies investigating patient safety issues by the use of eHealth are limited. A structured and continuous governmental control and regulation of patient safety in relation to the use of eHealth is warranted.

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“…All researchers had worked together prior to the focus group study to review the literature on various aspects of adherence of patient with psoriasis to topical drugs. 15,19…”

Section: Discussionmentioning

confidence: 99%

Limitations in Health-Care System Resources Affecting Adherence of Patient With Psoriasis to Topical Drugs: A Focus Group Study

Svendsen

Feldman

Tiedemann

et al. 2020

Journal of Psoriasis and Psoriatic Arthritis

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Background: Topical therapy is first-line treatment for patients with mild-to-moderate psoriasis, but low adherence to topical drugs is a barrier to treatment success. Health-care system resources are considered to have an impact on adherence of patient with psoriasis to topical drugs. Objective: To investigate dermatology nurses’ perception of the impact of health-care system resources on topical therapy adherence in patients with psoriasis. Methods: A semistructured focus group study was performed with 6 dermatology nurses and 2 student nurses. Participants were recruited from a dermatology outpatient hospital clinic. The study focused on the dermatology nurses’ perception of the effect health-care system resources (including health-care services provided to patients, how clinics are organized, and how the health-care personnel communicate) have on adherence of patients with psoriasis to topical treatment. The focus group discussion was divided into 3 areas: communication with patients and intercollegial communication, follow-up visits and admissions to consultations by other health-care professions, and how to establish consultations to support adherence of patients with psoriasis to topical drugs. Data were analyzed by a systematic text condensation method based on a phenomenological–hermeneutic approach. Results: Nurses identified a number of health-care system resources that may affect adherence of patients with psoriasis, primarily professional collaboration and communication, continuity of care, and the establishment of nurse consultations. Conclusion: Adherence may by negatively affected by contradictory information about topical drugs due to inadequate interprofessional collaboration among health-care professionals. Improving communication between health-care professionals and patients, ensuring continuity of care, and establishing nurse consultations may improve topical therapy outcomes.

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Improving psoriasis patients’ adherence to topical drugs: a systematic review

Cited by 18 publications

References 38 publications

Long-term improvement of psoriasis patients’ adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals

Long-term improvement of psoriasis patients’ adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals

Pros and cons of eHealth: A systematic review of the literature and observations in Denmark

Limitations in Health-Care System Resources Affecting Adherence of Patient With Psoriasis to Topical Drugs: A Focus Group Study

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