Prescription-level factors associated with primary nonadherence to dermatologic medications

A comparison of family physician and dermatologist topical corticosteroid prescriptions: A population-based cross-sectional study

BACKGROUND

Topical corticosteroids (TCS) are commonly prescribed to treat inflammatory skin diseases, and appropriate prescription is necessary for treatment success.

OBJECTIVE

To quantify differences between TCS prescribed by dermatologists at consultation and family physicians for patients treated for any skin condition.

METHODS

Using administrative health data in Ontario, we included all Ontario Drug Benefit recipients who filled at least one TCS prescription from a dermatologist at consultation and a family physician in the year prior between January 2014 and December 2019. We estimated mean differences and 95% confidence intervals in amount (in grams) and potency between the index dermatologist prescription and the highest and most recent family physician prescription amounts and potencies in the preceding year using linear mixed-effect models.

RESULTS

A total of 69,335 persons were included. The mean dermatologist amount was 34% larger than the highest amount and 54% larger than the most recent amount prescribed by family physicians. There were small but statistically significant differences in potency using established 7-category and 4-category potency classification systems.

CONCLUSIONS

Compared to family physicians, dermatologists prescribed substantially larger amounts and similarly potent TCS at consultation. Further research is needed to determine the effect of these differences on clinical outcomes.

Contact allergy to antifungals: results of a 12-year retrospective study

BACKGROUND

Contact allergy has been reported as a side effect of topical antifungals, although most evidence has come from small case series.

OBJECTIVE

Investigate the frequency and associated factors of contact allergy to topical antifungals.

METHODS

We performed a retrospective analysis of the data of the Contact Allergy Unit of a University Dermatology Department, between January 2009 and April 2021. From a cohort of 3788 patients tested in our unit, aimed testing was performed in 482 patients using topical antifungals (Chemotechnique Diagnostic, Vellinge Sweden or AllergEAZE) and, in some cases, commercial preparations "as is".

RESULTS

Contact allergy to antifungals was found in 27 patients (0.71% of consecutively tested patients and 5.6% of those who had aimed testing). Foot and leg eczema were the clinical presentation in 12 (44.4%) and 10 (37.0%) patients, respectively. Positive reactions were observed mostly with econazole nitrate 1% alc. (51.9%), miconazole 1% alc. (48.9%), tioconazole 28% solution (40.7%) and clotrimazole 5% pet. (18.5%). Fifteen patients (55.6%) presented sensitization to more than one antifungal.

CONCLUSIONS

Although contact allergy to antifungals was uncommon and occurred mostly associated with foot dermatitis. Most patients were sensitized to more than one chemical, particularly to azoles, which may limit future choices of topical antifungal treatment. This article is protected by copyright. All rights reserved.

Primary non-adherence to inhaled medications measured with e-prescription data from Poland

BACKGROUND

Treatment adherence greatly influences the clinical outcomes in various fields of medicine, including management of asthma and COPD. With the recent implementation of a nationwide e-Health solutions in Poland, new and unique opportunities for studying primary non-adherence in asthma and COPD emerged. The aim was to study primary non-adherence to inhaled medications available in Poland indicated in asthma and/or COPD and analyse the impact of patients' demographics and inhalers' characteristics (dry powder inhalers (DPIs) vs metered dose inhalers (MDIs) and presence of a dosage counter) on primary non-adherence.

METHODS

A retrospective analysis of all e-prescriptions issued in Poland in 2018 (n = 119,880) from the national e-prescription pilot framework.

RESULTS

Primary non-adherence for inhalable medications reached 15.3%. It significantly differed among age groups-the lowest (10.8%) was in 75 + years-old patients, highest (18%) in 65-74 years-old patients. No gender differences in primary non-adherence were found. The highest non-adherence was observed for ICS + LABA combinations (18.86%). A significant difference was found between MDI and DPI inhalers and between inhalers with/without a dosage counter.

CONCLUSIONS

Out of e-prescriptions for inhaled medications issued in 2018 in Poland, 15.3% were not redeemed. The degree of primary non-adherence was influenced by age, but not gender. Significant differences between MDIs and DPIs and between inhalers with/without a dosage counter were observed.

Assessment of Topical Corticosteroid Prescribing, Counseling, and Communication Among Dermatologists and Pharmacists

Importance

Topical corticosteroids (TCs) are common treatments for many dermatologic conditions. Anecdotal experience and literature suggest that dermatologists and pharmacists differ in their beliefs about TCs and approach to TC counseling, creating the opportunity for patient confusion.

Objective

To examine interprofessional practice gaps between dermatologists and pharmacists with regard to how each group views TCs, counsels patients on TC use, and communicates modifications to TC prescriptions.

Design, Setting, and Participants

An electronic survey was disseminated statewide in Wisconsin to 117 board-certified or eligible dermatologist members of the Wisconsin Dermatological Society and 2954 licensed pharmacists. The survey was performed from October 11, 2017, to January 2, 2018. Survey responses and demographic information were compiled and analyzed for each population.

Exposures

Study participants completed and returned a 17-question survey recalling experiences with TC prescribing from the past year along with self-reported demographic information.

Main Outcomes and Measures

Dermatologists' and pharmacists' self-reported counseling of patients regarding TC application, duration of use, and adverse effects; frequency of communication of changes to TC prescriptions and instructions; and demographic data were tabulated and compared.

Results

Of the 117 dermatologists, 52 (44.4%) completed and returned the survey; of the 2954 pharmacists, 111 (3.8%) returned the survey. Those no longer in active practice (3 dermatologists, 1 pharmacist) were excluded from analysis. A substantial proportion of pharmacists (51 [46.4%]) advised patients to limit TC use to 2 weeks or less, which was an uncommon strategy among dermatologists (3 [6.1%]) (P < .001). Discordance also was noted in the adverse effects that are emphasized in counseling, pharmacist-perceived and dermatologist-observed adverse effects in patients, and resources that inform counseling content. Only 8 (16.3%) dermatologists perceived that pharmacists made no unauthorized modifications to their TC prescriptions or instructions; however, 77 (70.0%) pharmacists reported not doing so (P < .001).

Conclusions and Relevance

An interprofessional practice gap appears to exist between dermatologists and pharmacists in Wisconsin regarding TC beliefs and counseling strategies. Collaborative education and improved communication between the 2 groups may be necessary to ensure that patients receive a unified, clear message about TC application and adverse effects. Larger studies are needed to further investigate this potential practice gap.