Tx noncompliance, depression intertwined. (Chronic Disease Patients).
Dr. Mark Goodfield and Dr. Sameh S. Zaghioul of the Leeds (England) Teaching Hospitals studied 201 patients with psoriasis and 32 with lupus erythematosus to compare medication levels with stated compliance.
More than 90% of lupus patients claimed to be taking their medication, but only 83% actually were complying with prescribed treatment regimens.
The numbers were worse for psoriasis patients, 92% of whom said they were taking their medications. Medication measurements revealed that just 61% were actually compliant.
The investigators found that in both diseases, married patients were more likely than single patients to be compliant.
Nonsmokers and nondrinkers (and those who drank little alcohol) were more likely than smokers and heavier drinkers to take their medication.
As expected, people who paid for their medication were more likely to use it, and those who endured no side effects were more compliant than those troubled by problems brought on by the drugs that were prescribed.
More psoriasis patients (93%) were compliant with once-daily medication regimens than with twice-daily prescriptions (52%).
Female psoriasis patients were more compliant than males. But age was not related to compliance for either psoriasis or lupus.
In one interesting finding, lupus patients were significantly more likely to adhere to medication regimens if those patients said they had a good relationship with their family doctors.
When investigators asked noncompliant psoriasis patients why they missed treatments, they replied that they were too busy (78%), forgot (56%), were "fed up" with treatment (43%), or had been drinking (37%).
The answers of patients to the Dermatology Life Quality Index (DLQI), an assessment of the psychosocial impact of skin disease, suggested strong links between compliance and psoriasis quality of life issues.
Among psoriasis patients, the mean DLQI score was 17.4 on a 0-30 scale; higher scores indicate greater impairment. There was a highly significant negative correlation between DLQI scoring and compliance.
The issue generated considerable discussion among clinicians who discussed the compliance findings during a poster discussion session at the meeting.
"We all have patients who don't comply, especially in chronic diseases," said Dr. Warren R. Heymann, who is head of the division of dermatology at the Robert Wood Johnson Medical School at Camden (N.J.).
"The most important factor, I think, that comes into play is depression. It's all tied in. People with a lousy quality of life may tend toward depression."
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|Publication:||Clinical Psychiatry News|
|Date:||Jul 1, 2003|
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