Using Side Effects to Promote Better Adherence

Enhancing Patients’ Treatment Adherence

Among the most commonly reported reasons for not taking medication are actual side effects and potential for side effects. Just the potential for side effects terrifies patients. Having actual side effects can quickly make people stop their medications.

To some extent, though, we can present side effects in a way that will encourage patients to continue treatment. When treatments are completely “silent,” patients may not know they are working and may lose enthusiasm for treatment. If we present side effects as a way of knowing that the medication is working, it may improve patients’ motivation to continue their treatment.

One of the most difficult adherence issues I face is getting patients to apply topical treatments to scalp psoriasis. With all the hair in the way, treating the scalp is a difficult, time-consuming task. If patients don’t feel like something is happening, they can quickly become discouraged and stop treatment. Some of the topicals have a lot of alcohol in them and can sting. The painful stinging may discourage patients from using the treatment. Some doctors might think the solution is to find a topical without the alcohol.  But another approach is to tell patients, “The stinging as a sign that the treatment is working” (and it is a sign the medication is working, because it is a sign that the medication is being effectively applied to the scalp and not just to the hair). When patients can feel something happening, it may encourage better use of treatment.

Perhaps the best example I’ve heard of using side effects to encourage better use of medication was with the use of spironolactone—an anti-androgen and diuretic—to treat acne in women. One doctor explained to me that when she puts women on spironolactone for their acne, she tells them, “Unfortunately this drug is also a diuretic, and you may notice some weight loss while you are on it.”

Whenever some minor tolerability issue can be anticipated to occur, it may be helpful to proactively explain it as a sign the medication is working, as at the very least, it is a sign of adherence to treatment.

—Dr. Steven Feldman is a professor of dermatology and public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC, where he studies patients’ adherence to treatment. He is also Chief Science Officer of Causa Reseach, an adherence solutions company, founder of and author of “Compartments”.