Currently, dermatology patients frequently do not fill their prescription medications. We hypothesize that this poor primary adherence (not filling a prescription for a new medication) reflects specific barriers to access, namely the frequently unpredictable and growing out-of-pocket cost to the patients and physicians' inadequate ability to screen and communicate with patients regarding the value of their medications. As an increasing number of patients carry high-deductible or tiered insurance plans, this problem will continue to grow.
Patient perceptions of barriers and facilitators that influence primary adherence to dermatologic medication are unknown. We propose a mixed methods study of patients with good and poor primary adherence to common dermatologic agents, creating a body of evidence about patient perception of the trade-offs between benefits, cost, and barriers to adherence. We will then use these findings to develop a toolkit to help providers communicate about value and screen for barriers to primary adherence in this patient population.
Specifically, the goals of our project are to:
1 - Identify barriers and facilitators of primary non-adherence (with a focus on systemic doxycycline, minocycline, and topical retinoids)
2 - Assess the role of out-of-pocket cost in patients' primary adherence and elicit optimal ways to screen for this barrier to adherence
3 - Create a provider toolkit for dermatologists and internal medicine physicians to improve primary adherence
4 - Develop a roadmap for implementing the toolkit in settings outside of the scope of this study (e.g., other dermatologic agents and other practice types)