Compliance is an issue for many patients with chronic conditions, but it’s particularly common in dermatology. By recognising the factors that contribute to compliance, we can help improve the effectiveness of treatment. 1
Sometimes patients can be non-compliant because of beliefs and concerns about the treatment they’ve been prescribed, e.g. they might not be using enough of their topical steroid because they’re worried about side effects. This is intentional (primary) non-compliance.
At other times, patients have practical problems with their treatment, e.g. older patients might have trouble reaching the affected area of skin, and so aren’t able to apply their emollient properly. This is unintentional (secondary) non-compliance.
Some of the common barriers to treatment compliance include: 1,2
Using topical treatments: the length of time it takes to apply a cream and the feeling of it on the skin, the frequency of applications needed, confusion or ignorance about the appropriate quantities or techniques to effectively apply emollient – the fact that the treatment plan doesn’t fit in with their lifestyle
Worries about the treatment like steroid phobia, which can sometimes be influenced by things people hear or read from inaccurate sources
The patient-doctor relationship: patients not always seeing the same doctor, and not being able to build a history with one healthcare professional
A lack of understanding or unrealistic expectations, of the condition or treatment 2
Practical problems: not being able to apply products properly due to poor mobility, living alone, adverse side effects, or not being able to afford products
Patients and healthcare professionals should work together to set expectations for treatment– patients need to appreciate the nature of their condition and the importance of compliance to treatment success
Finding an emollient the patient likes is one of the most important factors in improving compliance. Involving patients in decision-making will help make them more interested in their treatment – E45 provides patient testers which you can order online
By discussing how their treatment can fit into and around their lives, patients are more likely to find a routine that works for them day-to-day
Take as much time as possible to explain patients’ treatments – especially steroids; enhancing patients’ understanding of using steroids can help reduce fears associated with using them – it's important to help patients realise how effective steroids can be as well as the risks they pose.
If possible, arrange follow-up appointments with each patient to check on how they’re doing with their treatment plan