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Top 5 pearls for overcoming patient noncompliance


Up to 27% of acne patients don’t even get their prescriptions filled, let alone take them. So how do you increase compliance to get your patients well? Address the roadblocks, one expert says.

Patient noncompliance is a big deal. Up to 27% of acne patients don’t even get their prescriptions filled, let alone take them, one study shows.1 So how do you increase compliance to get your patients well? Address the roadblocks, one expert says.

1: Build trust

Steven R. FeldmanWinning patient trust is key. “Patients don’t trust drugs. They don’t trust drug companies. They don’t trust insurers. Patients trust their doctors. A trusted doctor is the foundation for getting patients to use their medicine,” says Steven R. Feldman, M.D., professor of dermatology, Wake Forest Baptist Medical Center, Winston-Salem, N.C.

You must appear trustworthy in addition to being trustworthy, he says. Think about what makes patients feel cared for and then do those things. Project a persona that is genuinely friendly, caring, personable, thorough, and organized.

Common trust-busters for patients include being perceived as messy, unfriendly, not thorough, or disorganized.


NEXT: Follow-up early and keep it simple


2: Follow-up early

Dr. Feldman says that follow-up at one week is essential-a return visit, an email or phone call-during which the patient reports how the medication is working.

“A one-week follow-up forces patients to fill the prescription right away; gets them in the habit of using the medicine; they see that it works with good use that first week. Then, they’ll keep using it either because they know it works or because they’re in the habit of using it,” Dr. Feldman says.

3: Keep it simple

Studies now indicate that the more complex the regimen, the less compliant the patient. Complicated regimens affect primary and secondary adherence. Dr. Feldman has found that, once patients had the medication, they used a single product containing two drugs better than they used separate drug products.2 He recommends prescribing combination medications, when appropriate, to simplify the treatment plan.

NEXT: Consider cost and explain, frame side effects


4: Consider cost

It’s not hard to guess that patients won’t comply if they can’t afford the treatment. High medication costs makes this issue particularly thorny.

Dr. Feldman says, “When I send a prescription to the pharmacy for a generic topical steroid [for example], there are instructions prepopulated into the electronic prescription notes to the pharmacist that if they have something of similar potency that’s less expensive to which the patient wants to switch, they can do that without even calling me. And if they have a question, they can call me on my cell.”

5. Explain, frame side effects

Side effects terrify people and cause them to stop using their medicine. But we can frame benign side effects as an advantage. A dermatologist once told Dr. Feldman that when she treats middle-aged women for hormonally-induced acne with spironolactone, an androgen blocker, she tells patients “Unfortunately, this drug is also a diuretic, and you might notice you’ll lose weight while taking the medication.”

 “The side effect is a potential adversity and you’re turning it into an opportunity,” Dr. Feldman says. “When I’m treating patients with scalp psoriasis with a generic topical steroid solution that stings, I’ll tell the patient, ‘This may sting; that’s a sign that it’s working.’ I never lie to patients. It’s true that it’s a sign that it’s working because it’s a sign that they got it on their scalp.”



1. Anderson KL, Dothard EH, Huang KE, Feldman SR. Frequency of Primary Nonadherence to Acne Treatment. JAMA Dermatol. 2015 Jun;151(6):623-6. http://www.ncbi.nlm.nih.gov/pubmed/25793290

2. Yentzer BA, Ade RA, Fountain JM, Clark AR, Taylor SL, Fleischer AB Jr, Feldman SR. Simplifying regimens promotes greater adherence and outcomes with topical acne medications: a randomized controlled trial. Cutis. 2010 Aug;86(2):103-8. http://www.ncbi.nlm.nih.gov/pubmed/20919606


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