The regular use of medications can be challenging for patients with chronic medical conditions. This is particularly true for dermatology patients where many conditions require long-term use of thick, greasy, ointments. Despite the availability of highly effective treatments for many dermatologic conditions, many people fail to see improvement. Nearly 40% of psoriasis patients report being unable to regularly use medications and with subsequent insufficent dosing, it is no surprise many patients don’t see improvement.
What Keeps Patients From Using Their Medications Regularly?
There are a variety of reasons patients do not use medications as directed by their doctor. Patients may not be very motivated to use their medication if their condition doesn’t bother them that much. Sometimes, the burden of using medication may be more than the burden of the skin condition itself. This is particularly true when conditions require messy ointments, where having greasy hands for hours or getting ointment on clothes may be worse than dry, itchy skin. Patients might not be able to afford their medications and may never pick it up from the pharmacy in the first place. Insurance plans often cover doctor’s visits but may not cover expensive prescription medications. Patients may not trust their doctor or may be afraid of the treatment. Patients may simply forget to use their medication or forget the specific instructions. And many patients give up using their medication after failing to see improvement quickly enough.
What Steps Can Patients Take to Make it Easier to Use Their Medications?
For patients that are not satisfied with the way their medication is provided (ointment, cream, foam, or solution) because it is too greasy, watery, or stings, they should ask their provider for an alternative. Generally a different form of the medication can be selected with the same active ingredient.
If your medication regimen is too complicated, ask your doctor to simplify the treatment. While alternating between corticosteroids and topical vitamin D may be slightly more effective for psoriasis, if you prefer to just use one medication or a topical that combines the two components, it may be a better option. In some cases, combined topical medications tend to be more expensive and may not be on one’s insurance formulary.
For patients on a budget, be sure to ask your dermatologist how much the medication will cost. For the same high strength clobetasol medication, the ointment may be more expensive than the cream. While many dermatologists prefer the ointment, if you cannot afford the medication, you should ask your dermatologist for an option that is within your budget.
Learning about the way medications work can be important. Topical steroids reduce inflammation in the skin as opposed to a moisturizer, which functions mainly to maintain hydration and provides a protective barrier from the environment. For patients that swear by Cocoa butter, they can be encouraged to continue using their preferred moisturizer while adding a prescription strength steroid to their routine. When topical therapies aren’t enough, it can be comforting to know that there are alternative treatments for many conditions such as light therapy and biologic medications. Ask your dermatologist for educational resources because information found through search engines is frequently not validated.
It is easy to have the best intentions to use a medication but simply forget. One trick is to place your medication in a convenient location. Some practitioners recommend putting medication next to the alarm clock; others may recommend placing medication in a sock drawer. This can be more effective than even having your medication in the bathroom because your mind is focused on other tasks such as brushing your teeth, making it easy to forget to use your medication.
One of the most important things you can do is to request a short follow-up appointment. Just think about piano lessons: if a student is given a sheet of music and told their recital is in 3 months and another student is scheduled for weekly lessons, who do you think will perform better? Often knowing you will see your dermatologist in a couple of weeks will help adherence.
Kids, teenagers, and older adults require a different set of tricks. Kids respond well to positive reinforcement. Parents can create a sticker calender for days in which they use their medication. Teenagers can be a challenge – often wanting to just be like everyone else. Parents can tell their teenager, “this is the medication that most other teenagers use for this condition.” For older adults, pill boxes and medication packs can be good tools to improve medication use.
Dermatologists may have their own methods for trying to get patients to use medications, but this article addresses some common barriers for medication use in patients and steps every individual can take to improve his/her own medication adherence. The best medication is the one in which you will use. Work with your dermatologist to come up with a personalized treatment plan that fits your lifestyle.
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