Mathias Tiedemann Svendsen1,2,3, Flemming Andersen1,3, Jakob Hansen4, Helle Johannessen5, Klaus Ejner Andersen1,2,3. 1. a Department of Dermatology and Allergy Centre , Odense University Hospital , Odense C , Denmark. 2. b Centre for Innovative Medical Technology, Institute of Clinical Research, University of Southern Denmark , Odense C , Denmark. 3. c Dermatological Investigations Scandinavia , Odense C , Denmark. 4. d Leo Pharma , Ballerup , Denmark. 5. e Research Unit of User Perspectives, Department of Public Health , University of Southern Denmark , Odense C , Denmark.
Abstract
OBJECTIVE: Topical corticosteroids and corticosteroid combinations are the principal treatments in psoriasis. The aim of this study was to investigate published literature dealing with medical adherence to topical corticosteroid or corticosteroid combinations in patients with psoriasis. MATERIALS AND METHODS: Systematic electronic searches in English language literature were done until September 2015 without publication date restriction. RESULTS: We identified 11 studies consisting of five surveys, two prospective studies, one qualitative study, one mixed-method study, one register study, and one interventional study. Observation periods varied and rates of nonadherence ranged from 8% to 88.3%. The rates were reported by patients on eight nonvalidated scales and one validated scale, measured by medication weight in two studies, and in two studies rates of nonadherence were measured using prescription registers. Thirty-four multifactorial determinants of nonadherence were found. One designed intervention consisted of a disease management program, which improved adherence in the study period. Overall, the studies included were heterogeneous in design and had a high risk of bias. CONCLUSION: To improve health outcome in topical treatment of psoriasis, further studies should be conducted addressing determinants of nonadherence and test interventions to improve adherence. Validated measurements of medical nonadherence, prescription registers, or medication-weight are needed.
OBJECTIVE: Topical corticosteroids and corticosteroid combinations are the principal treatments in psoriasis. The aim of this study was to investigate published literature dealing with medical adherence to topical corticosteroid or corticosteroid combinations in patients with psoriasis. MATERIALS AND METHODS: Systematic electronic searches in English language literature were done until September 2015 without publication date restriction. RESULTS: We identified 11 studies consisting of five surveys, two prospective studies, one qualitative study, one mixed-method study, one register study, and one interventional study. Observation periods varied and rates of nonadherence ranged from 8% to 88.3%. The rates were reported by patients on eight nonvalidated scales and one validated scale, measured by medication weight in two studies, and in two studies rates of nonadherence were measured using prescription registers. Thirty-four multifactorial determinants of nonadherence were found. One designed intervention consisted of a disease management program, which improved adherence in the study period. Overall, the studies included were heterogeneous in design and had a high risk of bias. CONCLUSION: To improve health outcome in topical treatment of psoriasis, further studies should be conducted addressing determinants of nonadherence and test interventions to improve adherence. Validated measurements of medical nonadherence, prescription registers, or medication-weight are needed.