Over the past few issues of this column, we’ve covered reasons why patients are non-adherent and the most important things doctors can do to enhance adherence, in particular, creating a strong, caring physician/patient relationship. In my research, I’ve found that patients are more adherent when participating in research studies than in real life practice, and that the accountability of return visits can drive adherence behavior. But so far, I’ve given you very little practical advice on how pharmaceutical marketers can influence adherence behavior.That’s about to change.

Can we bottle the principles described so far for improving adherence and implement them efficiently? Changing physician behavior isn’t easy and encouraging more office visits to physicians may not be practical, but I believe there is a way to give users of your products the feeling they are cared for, are involved in research and are accountable through weekly contact. It just so happens that an Internet-based survey was created to do just that.

A version of this study was tested in patients being treated for acne1 and it is now commercially available.2 In the study, patients with acne were given a topical treatment to use once a day. Half of the group was randomized to standard-of-care treatment, with return visits at six and 12 weeks. In addition to the return visits, the other half of the group was enrolled in a “survey study.” The survey was very short, and was designed to make people feel they were contributing to research, they were being cared for, and they felt accountable to report how well they were using the medicine each week. Adherence was measured using electronic monitors in the medication container caps.3

Adherence to topical treatment among teenage acne patients is horrible (not a big surprise there!) and, as expected, median adherence in the standard-of-care control was only 32%. Remarkably, adherence in the survey group was more than twice as high as the control group, with a median adherence of 74%. While patients in the control group rapidly dropped off treatment, patients who were in the survey group continued using the medication at a much higher rate.1

The Internet can be a powerful tool for good. This medium is a great way to reach out to not only teenagers, but a large and growing proportion of the population. While the Internet has already changed our lives in many ways, I doubt that we have seen the end of life-changing innovations. We may just be scratching the surface in how we can use this technology to enhance adherence and improve patients’ outcomes.



1. Yentzer BA, et al. An Internet-based survey and improvement of acne treatment outcomes. Arch Dermatol. 2011; 147:1223-4.

2. Causa Research, Winston-Salem, North Carolina.

3. Tusa MG et al. Adapting electronic adherence monitors to standard packages of topical medications. J Am Acad Dermatol. 2006; 55:886-7.

  • Steven Feldman, M.D.

    Dr. Steven Feldman is Professor of Dermatology and Public Health Sciences at Wake Forest Baptist Medical Center. Steve studies patient adherence at North Carolina’s Wake Forest Baptist Medical Center. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (www.causaresearch.com), founder of www.DrScore.com, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”


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