The Patient-Physician Relationship and Adherence: Observations From a Clinical Study

August 2023 | Volume 22 | Issue 8 | 838 | Copyright © August 2023


Published online July 31, 2023

doi:10.36849/JDD.7103

Patrick O. Perche BSa, Rohan Singh BSa, Madison K. Cook BSa, Katherine A. Kelly BSa, Esther A. Balogh MDa, Irma Richardson MHAa, Steven R. Feldman MD PhDa,b,c

aCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
bDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 
cDepartment of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC

Abstract
Improved patient-physician relationships (PPR) are associated with better patient satisfaction and disease outcomes, however, there is limited literature assessing how PPR affects adherence in dermatology. We recruited 30 subjects with a clinical diagnosis of rosacea. Subjects were instructed to use ivermectin 1% cream once daily for 3 months and adherence was measured using the Medication Event Monitoring System cap. The Patient-Doctor Relationship Questionnaire (PDRQ-9), a validated questionnaire assessing patients’ perceived strength of the relationship with their doctor, was completed. Mean adherence for all subjects over three months of the study was 62%. PDRQ-9 scores positively correlated with adherence rates for 3 months of treatment (r(26)=0.52; P=0.006). The perceived strength of the PPR may have a role in patients’ adherence to their medications. Improving the PPR, through empathy and effective communication, may facilitate better medication adherence and treatment outcomes. 

Perche PO, Singh R, Cook MK, et al. The patient-physician relationship and adherence: observations from a clinical study. J Drugs Dermatol. 2023;22(8):838-839. doi:10.36849/JDD.7103

INTRODUCTION

Adherence in dermatology can be very poor, particularly with topical medications and complex treatment regimens.1 Improved patient-physician relationships (PPR) are generally associated with better patient satisfaction, disease outcomes, and also adherence.2 However, there is limited literature assessing how PPR affects adherence in dermatology.3 We assessed how patient-reported PPR affects adherence in a clinical study of patients with rosacea.

MATERIALS AND METHODS

After Institutional Board Review approval (IRB00062694), 30 subjects with a clinical diagnosis of rosacea were recruited from the Atrium Health Wake Forest Baptist Department of Dermatology clinics. Subjects were instructed to use ivermectin 1% cream once daily for 3 months with visits at baseline and 3-month follow-up. The Medication Event Monitoring System (MEMS®), a cap with an electronic device that records the time and date of cap removal, was used to measure adherence over a 3-month period.4 Subjects were not informed about the adherence monitoring until the end of study. The Patient-Doctor Relationship Questionnaire (PDRQ-9), a validated questionnaire assessing patients' perceived strength of the relationship with their doctor, was completed at the follow-up visit (Table 1).3  The PDRQ-9 consists of 9 questions, each graded on a 1-5 Likert scale (1 = not at all appropriate, 2 = somewhat appropriate, 3 = appropriate, 4 = mostly appropriate, 5 = totally appropriate), with a range of 9 to 45; higher scores indicate greater strength of PPR (Table 1). Three subjects were excluded (two lost to follow-up and one failure to follow protocol). Data were stratified based on PDRQ-9 scores of less than or equal to 36 and greater than or equal to 37, age < 50 and greater than or equal to 50, and gender. Differences in group comparisons were analyzed with Student’s t-test and correlation between PDRQ-9 and adherence