Conflicts of interest: None declared
Objective assessment of compliance with treatments in acne
Article first published online: 10 MAR 2005
British Journal of Dermatology
Volume 152, Issue 5, pages 1015–1021, May 2005
How to Cite
Zaghloul, S.S., Cunliffe, W.J. and Goodfield, M.J.D. (2005), Objective assessment of compliance with treatments in acne. British Journal of Dermatology, 152: 1015–1021. doi: 10.1111/j.1365-2133.2005.06357.x
- Issue published online: 28 APR 2005
- Article first published online: 10 MAR 2005
- Accepted for publication 16 July 2004
- medication adherence;
- psychosocial determinants;
- quality of life;
- treatment distribution
Summary Background Acne occurs in prepubertal individuals, teenagers and adults, and can have a devastating effect on self-esteem and social relationships. Whether an acne sufferer will seek treatment often depends, apart from the severity, on cultural and social aspects, which play a significant role in the attitude of the individuals and how they cope with the condition. Compliance with treatment regimen is an essential element in overall effectiveness of therapy.
Objectives To assess patient compliance in acne vulgaris.
Methods In an open prospective study at a dermatology outpatient clinic, patients with acne, and on isotretinoin or conventional therapies, were examined and completed a questionnaire consisting of: (i) a brief medical and social history, (ii) a compliance assessment sheet, and (iii) the Dermatology Life Quality Index (DLQI). Patients were re-examined after 3 months and their actual treatment usage was directly assessed and compared with expected use. The objective medication adherence (Med Ad) was calculated as (actual treatment use/expected treatment use) × 100. The interview (self-report) Med Ad was obtained by direct questioning. To avoid influencing the behaviour of the subjects, they were not informed of the specific aim of the study: the Local Research Ethics Committee gave approval for this approach. Patient attendance was recorded by referring to the outpatient clinic appointment charts.
Results Of 687 patients seen who fulfilled the inclusion criteria, 403 completed the study. The mean ± SD overall objective Med Ad was 64·7 ± 24% (range 0–111%). The mean ± SD DLQI was 17·7 ± 8·1 (range 2–30). There was a highly significant negative correlation (r = −0·87) between DLQI scores and Med Ad. The correlation between age and Med Ad was significantly negative (P < 0·01). Being female, married, employed and not paying for prescriptions were characteristics associated with increased Med Ad and a lower DLQI. Med Ad was greater for isotretinoin therapy and for first time usage of isotretinoin. The major reasons for missing treatment given by the patients were being fed up, forgetful or too busy. Smoking cigarettes and drinking alcohol resulted in reduced Med Ad. The mean ± SD interview Med Ad was 93·9 ± 5% (range 85–100%).
Conclusions The study demonstrates that a range of disease-related and social factors may influence compliance with treatment in acne. The inverse relationship between DLQI and Med Ad probably reflects the profound interaction of physical and psychological factors as well as perceived treatment failure.