Improving compliance with cosmeceutical-prescription combinations

April 28, 2017|Dermatology News

As clinicians who have been in practice for even a relatively short period of time know, patient compliance is an integral aspect of achieving optimal patient outcomes. However, studies show that patient compliance with treatment of many dermatologic disorders, including acne and psoriasis, is often poor.^1,2

In 2007, Feldman showed that patients are more likely to use their products in the days before and the days after their dermatologist visit.³ He suggested that more frequent office visits would boost compliance. I have found that this is true and I recommend seeing patients every 4 weeks when implementing a new treatment regimen. I have also found that combining prescription medications with the proper corresponding skin care products helps decrease side effects and speed results when patients apply the products correctly.

To increase the chance of patients using the products correctly, they should be educated about how and when to use the products. I cannot overemphasize the importance of this, as illustrated by the following story of a patient who came in with facial redness and irritation. Upon questioning, I learned that she was using her facial cleanser but was not washing it off and left it on all day. She said, “No one told me to wash it off!” While washing a cleanser off may seem obvious, cultural, gender, ethnic, and geographical differences can lead to misunderstandings.

The problem with patient education is that it takes time. It is best if education is provided by staff, but keeping them trained and up to date is also difficult. Most dermatologists only have 3-5 minutes per patient so streamlining the process of designing a treatment plan and educating the patient and recruiting your staff to help is crucial. Before I discuss how to streamline the process, let’s first look at our goals for patients.

To achieve good patient outcomes, the patient needs to:

Understand what medications and products to use.
Understand when and how to use the products.
Understand the order in which to use the products (step 1, step 2, etc.).
Purchase the products (from you or elsewhere).
Tell you if they do not purchase the products, for whatever reason (insurance will not cover, too expensive, could not find them, etc.).
Use the products consistently.
Inform you if they do not use the products (too busy, did not have them on a trip, etc.).
Report any side effects so you can adjust the therapy accordingly.

You can see why it is so difficult to get patients to be compliant. Many factors – such as time, memory, education level, understanding, motivation, cost, convenience, and insurance coverage – can get in the way of these important components. Giving patients a printed regimen with instructions, selling the products in your practice, and providing some sort of interaction to keep patients engaged is key. In my June 2015 Dermatology News column, I discussed why you should consider selling products in your practice. In the future, I will discuss ways to engage your patients, but for now, let’s focus on how to quickly and effectively provide your patients with printed regimens and patient instructions without increasing office visit times.

Streamlining the Process of Generating a Skin Care Regimen That Includes Prescription Medications

Identify patients’ phenotypes

Divide patients into phenotypes based on skin care needs to save yourself time with the recommendation process.

Many doctors do this with a disease-based approach, such as acne, rosacea, eczema, psoriasis, etc. I prefer to classify my patients according to 16 Baumann Skin Types based on four parameters: hydration status, propensity for inflammation; presence or absence of uneven pigmentation; and presence of lifestyle habits, such as sun exposure, that increase an individual’s risk of skin aging.^4,5,6 To quickly diagnose the patient as a particular Baumann Skin Type, I use a tablet-based validated questionnaire called the Baumann Skin Type Indicator (BSTI).⁷ This questionnaire is self-administered by the patient in the waiting room and serves several purposes that facilitate my practice:

To collect historical and current data.
To diagnose skin type.
To ask specifically about skin allergies.
To learn preferences such as tinted vs. nontinted, or chemical vs. physical sunscreen.
To inquire about what issues the patient wants to discuss, such as thinning eyelashes, hair loss, dry body skin, toenail fungus, warts, eczema, and other topics that might not come up during the appointment.
To learn and document habits that affect the skin, such as tanning bed exposure, sun exposure, and smoking.
To stimulate the patient to think about how daily actions such as sunscreen use and sun exposure affect their skin health.