Thought leaders share strategies for talking to patients about the importance of treatment adherence in the long-term management of atopic dermatitis.
Andrew F. Alexis, MD, MPH: Speaking of adherence, when we’re [managing] a long-term chronic, inflammatory disorder such as AD [atopic dermatitis], what are your thoughts on why treatment adherence in patients with AD can sometimes be a challenge, and [why] there tends to be historically low rates of adherence?
Benjamin N. Lockshin, MD: I’ll say globally. No matter what disease state you’re [managing], even when you set the bar high in terms of risk, such as cancer treatments, [adherence to] medications is far from perfect. When you add into the mix the fact that this is an injectable, patients’ perceptions are that it just may be scarier. I will stress the term “patients’ perceptions”—that adds to it. The second thing is because this medication or these classes of medications do produce meaningful results, many of the patients who are doing really well think that they no longer need the medication, so they electively become somewhat noncompliant, which is a little frustrating to me because I spent a lot of time talking about the fact that this is a chronic inflammatory condition and dysregulation of the immune system. We’re using specialized medication to target that dysregulation and to balance things out. We are not curing, we’re managing. But patients do their own thing, I think we’ve all seen that. You have to be accepting of the fact that patients want to be part of the decision-making process, but it is our job to educate them about the risk and benefits of the decisions they make. What hurdles do you encounter in terms of your patients’ adherence to medications?
Andrew F. Alexis, MD, MPH: From the initial consultation, [I focus on] conveying that this is a chronic disorder that’s going to require long term control; it’s more of a marathon than a sprint. [I say] it in a way that’s a little bit more uplifting and positive than that because patients feel down when you use words like chronic. [I explain] that we’re going to be managing this over the long term, it’s not just we’re going to treat the rash that’s here today and then we’re going to stop everything and wait for it to come back. So [I emphasize] a strategy of longitudinal control; you can use whatever language you like to use for a patient that they understand and that’s acceptable to them, but [I emphasize] that the concept of long-term management for the best possible outcomes is really crucial.
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