Published: 2022-08-25

Primary drug non-adherence in dermatology patients: prevalence, pattern and reasons

Ehiaghe L. Anaba, Babawale Arabambi


Background: Primary drug non-adherence, a pervasive problem in dermatology is not readily documented despite the adverse effect of this phenomenon on the management of patients. The aim of the study was to document the prevalence, pattern and reasons for primary drug non-adherence in dermatology patients.

Methods: This prospective cross-sectional questionnaire based study was conducted from June to December 2021 amongst 302 consecutive consenting adult patients returning to the dermatology clinic following an initial diagnosis and a prescription for medications. Data collected included socio-demographic parameters, primary drug adherence, and number of drugs prescribed, number not purchased, and reason for non-adherence. Data analysis was done in R Studio [R Core Team (2021)].

Results: Three hundred and two (302) patients aged 13 to 87 years with a mean age of 41.72±18.8 years were recruited into the study. Prevalence of primary non-drug adherence was 26.2% (79/302). Amongst the non-adherent patients; 73.4% were females and 26.6% were males. The reasons for non-drug adherence ranged from non-availability of drug (63.3%) to patient forgetting about the prescription. (1.3%). Route of drug not adhered to was Topical in 72%, Oral in 22.7%, oral and topical in 5.3.

Conclusions: Primary drug non-adherence is common with dermatology patients. The propensity for primary non-drug adherence is increased when the number of drugs prescribed are more than three. Dermatologists need to consider the use of drugs capable of addressing multiple symptoms and thereby reduce the number of drugs prescribed.  



Drug non-adherence, Dermatology, Prevalence, Steroids, Dermatology patients

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Martini ND, Werf B, Clarke D. Primary medication non-adherence at Counties Manukau Health Emergency Department (CMH-ED), New Zealand: an observational study. BMJ Open. 2020;10(7):e035775.

Adamson AS, Suarez EA, Gorman AR. Association Between Method of Prescribing and Primary Nonadherence to Dermatologic Medication in an Urban Hospital Population. JAMA Dermatol. 2017;153(1):49-54.

Kassavou A, Sutton S. Reasons for non-adherence to cardiometabolic medications, and acceptability of an interactive voice response intervention in patients with hypertension and type 2 diabetes in primary care: a qualitative study. BMJ Open. 2017;7(8):e015597.

Anderson KL, Dothard EH, Huang KE, Feldman SR. Frequency of Primary Nonadherence to Acne Treatment. JAMA Dermatol. 2015;151(6):623-6.

Young JA, Suarez EA, Adamson AS. Distance to pharmacy and risk of medication primary nonadherence. Dermatol Online J. 2018;24(2):13030.

Cheen MHH, Tan YZ, Oh LF, Wee HL, Thumboo J. Prevalence of and factors associated with primary medication non-adherence in chronic disease: A systematic review and meta-analysis. Int J Clin Pract. 2019;73(6):e13350.

Hines A, Campbell E, Hornback L, Sokola M, Hobbs M, Hooper P, et al. Adherence with Dermatology Consultant Recommendations: A Retrospective Study of 417 Hospital Dermatology Consultations. JAAD. 2020.

Dommasch ED, Lee MP, Joyce CJ, Garry EM, Gagne JJ. Drug utilization patterns and adherence in patients on systemic medications for the treatment of psoriasis: A retrospective, comparative cohort study. J Am Acad Dermatol. 2018;79(6):1061-8.

Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease - strategies for optimizing treatment outcome. J Eur Acad Dermatol Venereol. 2019;33(12):2253-63.

Lee SQ, Raamkumar AS, Li J, Cao Y, Witedwittayanusat K, Chen L, et al. Reasons for Primary Medication Nonadherence: A Systematic Review and Metric Analysis. J Manag Care Spec Pharm. 2018;24(8):778-94.

Kardas G, Panek M, Kuna P, Cieszyński J, Kardas P. Primary Non-Adherence to Antihistamines-Conclusions From E-Prescription Pilot Data in Poland. Front Pharmacol. 2020;11:783.

Thorneloe RJ, Griffiths CEM, Emsley R, Ashcroft DM, Cordingley L, British Association of Dermatologists Biologic Interventions Register, et al. Intentional and Unintentional Medication Non-Adherence in Psoriasis: The Role of Patients' Medication Beliefs and Habit Strength. J Invest Dermatol. 2018;138(4):785-94.

Seal F, Cave AJ, Atkinson LL. Primary Non-Adherence of Prescribed Pharmaceutical Treatments and Interventions: An Investigative Review to Improve Quality in Primary Care. Quality in Primary Care. 2017;25: 344-59.

Anaba EL, Oaku RI. Indigenous therapies for skin diseases in sub-Saharan Africa. Dermatol Ther. 2019;32(4):12974.

Truong A, Laggis CW, Annis TD, Secrest AM, Fino NF, Powell DL, et al. Factors associated with follow-up adherence in patients seen at a referral-based dermatology clinic for the homeless. J Am Acad Dermatol. 2020;83(2):629-31.

Anaba EL, Cole-Adeife MO, Oaku RI. Prevalence, pattern, source of drug information, and reasons for self-medication among dermatology patients. Dermatol Ther. 2021;34(2):e14756.

Rutherford A, Glass DA, Suarez EA, Adamson AS. Prescription-level factors associated with primary nonadherence to dermatologic medications. J Dermatolog Treat. 2018;29(3):300-4.

Li AW, Yin ES, Antaya RJ. Topical Corticosteroid Phobia in Atopic Dermatitis: A Systematic Review. JAMA Dermatol. 2017;153(10):1036-42.