Identifying and addressing barriers to primary adherence with acne medications: development of a qualitative data-sourced toolkit

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)