Time Intervals Until the First Return Office Visit After New Medications

December 2020 | Volume 19 | Issue 12 | Original Article | 1226 | Copyright © December 2020


Published online November 30, 2020

Suraj Muddasani BSa, Courtney E Heron BSb, Alan B Fleischer Jr MDc, Steven R Feldman MD PhDb, d, e, f

aCollege of Medicine, University of Cincinnati, Cincinnati, OH
bCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
cDepartment of Dermatology, University of Cincinnati, Cincinnati, OH
dDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
eDepartment of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
fDepartment of Dermatology, University of Southern Denmark, Odense, Denmark

Abstract
Introduction: Poor patient adherence to medications is common in dermatology and can result in negative health outcomes. A short interval until the first return office visit after starting a medication can increase adherence.
Methods: We conducted a retrospective cross-sectional study by using the National Ambulatory Medical Care Survey from 2014 to 2016 to determine the length of time until the scheduled return visit.
Results: Our study examined 10.9 (95% confidence interval 9.43, 12.5) million estimated visits in the NAMCS. Patients with acne, atopic dermatitis, and psoriasis prescribed at least one new medication had dispositions to return at two months or greater or to return as needed at 73.5% (38.8, 100), 49.1% (12.6, 92.0), and 55.0 % (14.0, 100) of visits, respectively.
Conclusions and Relevance: The time for a first return visit is frequently more than two months after a new medication is prescribed. Incorporating an earlier visit when prescribing a medication may be a means to improve adherence.

J Drugs Dermatol. 2020;19(12):1226-1230. doi:10.36849/JDD.2020.5542

INTRODUCTION

Negative health outcomes stemming from poor medication adherence account for 36% to 69% of yearly hospital admissions and increase healthcare costs by about $100 billion United States (US) dollars a year.1,2 The prevalence of poor drug adherence to topical treatments is high in dermatology.3 Improving patient adherence can improve disease severity and quality of life in several dermatologic diseases such as acne, atopic dermatitis (AD), and psoriasis.4-7

Poor adherence to medications may also be related in part to the length of time between the initial and return office visit after prescription of a new medication. Adherence increases around the time of an office visit, and is generally greater near the day of a scheduled office visit before decreasing rapidly in the days afterwards.8,9 Shorter times to the first follow up are associated with better treatment adherence.8

Despite the evidence that shorter times to first follow up improve adherence, traditionally physicians often do not have patients return for 2 months or longer after starting a new prescription. The purpose of this study is to determine the time interval from prescription of a new medication until the next recommended return visit in US patients with acne, AD, and psoriasis.

METHODS

The Center for Disease Control and Prevention conducts the National Ambulatory Medical Care Survey (NAMCS), a yearly survey that queries physicians primarily in the ambulatory setting who are not federally employed. Physicians who are queried log data in a random week of every year. The logged data includes physician diagnosis, interval until patients return, and medications prescribed. As part of its structure, the survey uses a three-stage probability sampling design. 112 primary sampling units (PSU) are created on the basis of geographic region as part of the first stage. Physicians are then separated into specialty groups within each PSU in the second stage. Patient visits within individual practices are examined in the third stage. Each visit is given an inflation factor, the patient visit weight, which takes into account the probabilities of selection at each stage, adjusts for nonresponses, and post-ratio adjustments, and incorporates a weight smoothing technique.10-12

We analyzed this data set for all visits where International Classification of Diseases Ninth Edition (ICD-9) codes 706.1, 696.1, 691.8, and ICD-10 codes L70.0, L40.0, and L20.9 were the primary diagnosis. These represent diagnoses of other acne, other psoriasis, other atopic dermatitis, acne vulgaris, psoriasis vulgaris, and atopic dermatitis (unspecified), respectively.13