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Association of Dissatisfaction With Care and Psychiatric Morbidity With Poor Treatment Compliance
Cristina Renzi, MD, MSc;
Angelo Picardi, MD;
Damiano Abeni, MD, MPH;
Elisabetta Agostini, BD;
Giannandrea Baliva, MD;
Paolo Pasquini, MD, MPH;
Pietro Puddu, MD;
Mario Braga, MD, MSc
Arch Dermatol. 2002;138:337-342.
Objectives To examine factors associated with compliance with dermatologic treatment.
Design Longitudinal study. Quality of life and psychological well-being were
measured before the dermatologic visit with a self-completed questionnaire.
Telephone interviews were performed 3 days and 4 weeks after the visit to
evaluate patient satisfaction and medication adherence, respectively.
Setting Outpatient clinics of a large dermatologic hospital in Rome, Italy.
Patients A total of 1389 outpatients were contacted and 722 (52%) agreed to participate.
Among them, 424 responded to the inclusion criteria and were enrolled in the
study. Of these, 396 (93%) completed the telephone interviews.
Main Outcome Measure Self-reported compliance with dermatologic treatment.
Results The dermatologists' prescriptions were not exactly followed by 44% of
patients. In multiple logistic regression analysis, treatment adherence was
strongly associated with complete satisfaction. Poor quality of life on the
emotions scale (indicating mainly high levels of shame and embarrassment)
was also associated with medication adherence. On the contrary, a strong negative
association was observed between psychiatric morbidity and compliance.
Conclusions This is the first longitudinal study on dermatologic patients showing
that dissatisfaction with care and psychiatric morbidity are significantly
and independently associated with poor medication adherence. To improve medication
adherence, particular attention should be dedicated to the physician's interpersonal
skills, which emerged as a major component of patient satisfaction. Moreover,
our results highlight the need for a timely identification and appropriate
management of psychiatric disorders in everyday dermatologic practice.
From the Health Care Quality Research Unit (Drs Renzi and Braga and
Ms Agostini), Clinical Epidemiology Unit (Drs Picardi, Abeni, and Pasquini),
III Dermatological Clinic (Dr Baliva), and Dermatoimmunology Department (Dr
Puddu), Istituto Dermopatico dell'Immacolata–Istituto di Ricovero e
Cura a Carattere Scientifico, Rome, Italy.
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