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Brief Report
April 2018

The Role of the Physician in Patient Perceptions of Barriers to Primary Adherence With Acne Medications

Author Affiliations
  • 1Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
  • 2Division of General Internal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
  • 3Penn Center for Healthcare Innovation, University of Pennsylvania Health System, Philadelphia
  • 4Department of Dermatology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
JAMA Dermatol. 2018;154(4):456-459. doi:10.1001/jamadermatol.2017.6144
Key Points

Question  What are the barriers to patients’ primary adherence with prescribed acne medications, and are there opportunities for physicians to intervene?

Findings  This qualitative analysis of 26 structured patient interviews found that cost is the major barrier to initiating therapy. Patients noted actions by physicians that could improve primary adherence, including having a plan of action if patients are unable to fill a prescription.

Meaning  Physicians must be cognizant that cost (including copays and prior authorizations) is a barrier for patients to receive acne medications, and there may be opportunities to anticipate and intervene to prevent problems with primary adherence.


Importance  Primary nonadherence with acne medications is high but commonly underreported to prescribing physicians.

Objectives  To describe patient experiences with primary nonadherence to medications for acne and to identify physician-level factors that may improve adherence in this population.

Design, Setting, and Participants  A qualitative analysis was conducted from structured interviews with patients reporting nonadherence with acne medications at a large academic health system in the Philadelphia, Pennsylvania, area. Three hundred eighty-five patients from 4 dermatology practices in the Philadelphia area were screened for primary nonadherence with a newly prescribed acne medication. Twenty-six patients participated in structured interviews conducted between November 30, 2016, and January 31, 2017.

Main Outcomes and Measures  Thematic analysis of the transcripts was performed to detect recurrent themes and divergent ideas with a focus on modifiable physician-level factors that might improve primary adherence to medications for acne.

Results  Participants (19 [73%] women, 6 [23%] aged <26 years, 15 [58%] aged 26-40 years, and 5 [19%] aged >40 years) reported cost as the major barrier to initiating therapy. Despite anticipating this barrier, they rarely brought up costs with physicians during the initial visit and generally did not expect their physician to be knowledgeable in this area. Although patients experienced inconvenience and frustration when unable to fill their prescriptions, this experience did not appear to negatively affect their satisfaction with the prescribing physician. Nevertheless, warning patients that the preferred medication may be expensive, having a plan of action if patients were unable to fill the prescription, and securing the patient’s commitment to the plan were described as actions that the physicians could take to improve primary adherence.

Conclusions and Relevance  Physician-level interventions to improve primary adherence to medications for acne may have an impact on nonadherence with costly medications, although they may not affect patient satisfaction with the prescribing physician.

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