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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
The role of patient satisfaction and adherence in skin diseases
Chronic skin diseases and patient involvement in health care
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Andrea W.M. Evers, Nijmegen, The Netherlands Radboud University Nijmegen Medical Centre, Elisabeth W.M. Verhoeven, Floris W. Kraaimaat, Piet Duller, Pieter G.M. van der Valk, Henk J.M. van den Hoogen, Johannes H.J. Bor, Henk J. Schers, Peter C.M. van de Kerkhof, & Chris van Weel
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Skin diseases are a substantial part of the problems dealt with by family physicians. In response to our publication on the prevalence and health care use of skin diseases in family practice, Renzi and Maestroni emphasize the important role of an open doctoral-patient discussion to increase patient satisfaction and to discuss the use of CAM (complementary and alternative medicine) or problems with treatment adherence. In line with Renzi and Maestroni, this and previous studies have shown that the use of CAM is particularly prone in patients who experience more limitations in daily life due to their condition (1,2). In addition, non- adherence is a well-known problem in dermatology (3-9). For example, we found that about 70% of patients with psoriasis reported that they were non-adherent at some stage (10). This relatively high level of non- adherence interfered with the effects of regular dermatological treatment, particularly the follow-up results after successful UVB treatment. The findings underline the need to integrate adherence assessment and to offer interventions that successfully increase patients’ commitment and self- managements skills when dealing with the instructions and advice given (family) physicians. A key to this is in assessing, early in the episode of care, patients’ expectations and their reasons to seek medical care, in addition to the diagnosis. Since there is evidence that non-adherence is also related to a lower quality of life and treatment-related factors, such as less satisfaction with treatment and fear of side effects (3-9), treatments directed at improving both the quality of life of patients and doctor-patient relationships might also improve treatment adherence and consequently treatment efficacy (11-13). References
Competing interests: None declared |
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Cristina Renzi, Rome, Italy Clinical Epidemiology, IDI-IRCCS, Simona Mastroeni
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Skin diseases often have an important impact on health related quality of life (QoL) and on health care costs. For example, the effects of atopic dermatitis on patients' QoL and psychosocial well-being are comparable to those of diabetes or hypertension (1,2). Verhoeven et al. highlight the relatively high prevalence of skin diseases encountered by family physicians, with 65.1% of patients affected by skin diseases seeing only their family physician for the skin problem. Patients with more sever diseases and worst health-related QoL access health services more frequently. Interestingly, patients using complementary and alternative medicine (CAM) have the lowest level of QoL and more severe diseases. In a recent study we examined attitudes and experiences regarding CAM on a sample of 573 dermatological patients, showing that patients satisfied with the information regarding the skin disease received by their physician were significantly less likely to use CAM (Odds Ratio (OR)=0.50; 95% Confidence Interval (CI) 0.31-0.79; p=0.006) (Renzi C et al., manuscript in preparation). One of the main reasons for using CAM was that patients were not satisfied with “conventional care” (26%). Only 36% of patients using CAM informed their physician. We have previously shown among a sample of 396 dermatological out-patients that satisfaction with care was increased by physicians’ ability to give explanations to patients (OR=5.21; 95%CI 2.7-10.0; p<0.001) and to show to care for patients' health (OR=1.92; 95%CI 1.1-3.7; p=0.048) (3). Dissatisfaction was associated with poor treatment compliance (OR=2.24; 95%CI 1.3-3.9; p=0.004) (4). Insufficient information, unexpressed patient preferences for some treatment options and prejudices or concerns regarding other treatments (e.g. corticophobia) can be associated with suboptimal disease management, increased use of healthcare resources, including CAM, use of non-evidence based treatments and negative health outcomes (2,5). Thus, the importance of an open doctor-patient discussion, including also questioning patients regarding possible CAM use, should be emphasized. This can also help prevent possible drug-herb interactions, considering that often patients do not disclose CAM use, if not directly asked (6). In order to optimize care, it is important to evaluate patients’ concerns and expectations, actively involving the patient in a shared treatment plan. This is particularly relevant for chronic diseases needing long term treatments and affecting QoL. References
Competing interests: None declared |
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