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      Development of an adherence-enhancing intervention in topical treatment termed the topical treatment optimization program (TTOP)

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          Abstract

          Psoriasis is a common, disabling, chronic, relapsing, inflammatory disorder of the skin with a worldwide prevalence of 2–3 % in which adherence to treatment is often poor. The majority of individuals have limited disease that is being treated with topical medication according to existing guidelines. Adherence rates are lower for topical compared with systemic treatment. Low medication adherence is a major problem for patients with chronic disorders as it results in suboptimal treatment outcomes, increased risk for development of concomitant diseases, inefficient use of health resources and considerable losses to society. However, to date no adherence-enhancing intervention has been developed for psoriasis patients under topical treatment. In this article, we report the development of the topical treatment optimization program (TTOP). The TTOP intervention aims to improve the information given to the patients and to result in an engaged patient–physician relationship. Application of the TTOP intervention in daily clinical practice may lead to a significant increase of adherence and the successful management of psoriasis and other chronic skin disorders.

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          The online version of this article (doi:10.1007/s00403-014-1475-5) contains supplementary material, which is available to authorized users.

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          Pathogenesis and therapy of psoriasis.

          Michelle Lowes, Anne M Bowcock, James G. Krueger (2007)
          Psoriasis is one of the most common human skin diseases and is considered to have key genetic underpinnings. It is characterized by excessive growth and aberrant differentiation of keratinocytes, but is fully reversible with appropriate therapy. The trigger of the keratinocyte response is thought to be activation of the cellular immune system, with T cells, dendritic cells and various immune-related cytokines and chemokines implicated in pathogenesis. The newest therapies for psoriasis target its immune components and may predict potential treatments for other inflammatory human diseases.
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            The challenge of patient adherence

            Leslie Martin, Summer Williams, Kelly B Haskard … (2005)
            Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients, and the nurturance of trust in the therapeutic relationship. Patients must be given the opportunity to tell the story of their unique illness experiences. Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes.
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              Definition of treatment goals for moderate to severe psoriasis: a European consensus

              U. Mrowietz, K. Kragballe, K Reich … (2010)
              Patients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi procedure were carried out. Nineteen dermatologists from different European countries met for a face-to-face discussion and defined items through a four-round Delphi process. Severity of plaque psoriasis was graded into mild and moderate to severe disease. Mild disease was defined as body surface area (BSA) ≤10 and psoriasis area and severity index (PASI) ≤10 and dermatology life quality index (DLQI) ≤10 and moderate to severe psoriasis as (BSA > 10 or PASI > 10) and DLQI > 10. Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. For systemic therapy of plaque psoriasis two treatment phases were defined: (1) induction phase as the treatment period until week 16; however, depending on the type of drug and dose regimen used, this phase may be extended until week 24 and (2) maintenance phase for all drugs was defined as the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, the change of PASI from baseline until the time of evaluation (ΔPASI) and the absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if reduction in PASI is ≥75%. The treatment regimen should be modified if improvement of PASI is 5 but can be continued if the DLQI is ≤5. This programme defines the severity of plaque psoriasis for the first time using a formal consensus of 19 European experts. In addition, treatment goals for moderate to severe disease were established. Implementation of treatment goals in the daily management of psoriasis will improve patient care and mitigate the problem of undertreatment. It is planned to evaluate the implementation of these treatment goals in a subsequent programme involving patients and physicians.
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                Author and article information

                Contributors
                Ina Zschocke: +49-040-55 44 010 , ina.zschocke@sciderm.com
                Journal
                Journal ID (nlm-ta): Arch Dermatol Res
                Journal ID (iso-abbrev): Arch. Dermatol. Res
                Title: Archives of Dermatological Research
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0340-3696
                ISSN (Electronic): 1432-069X
                Publication date (Electronic): 4 June 2014
                Publication date PMC-release: 4 June 2014
                Publication date (Print): 2014
                Volume: 306
                Pages: 667-676
                Affiliations
                [ ]Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany
                [ ]Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Schittenhelmstraße. 7, 24105 Kiel, Germany
                [ ]SCIderm GmbH, Drehbahn 1-3, 20354 Hamburg, Germany
                Article
                Publisher ID: 1475
                DOI: 10.1007/s00403-014-1475-5
                PMC ID: 4139584
                PubMed ID: 24895177
                SO-VID: f4996f74-3846-4976-9994-144cab629415
                Copyright © © The Author(s) 2014
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                Date received : 14 May 2013
                Date revision received : 13 May 2014
                Date accepted : 19 May 2014
                Categories
                Subject: Original Paper
                Custom metadata
                issue-copyright-statement © Springer-Verlag Berlin Heidelberg 2014

                ScienceOpen disciplines: Dermatology
                Keywords: adherence,intervention,topical therapy,psoriasis,ttop
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: adherence, intervention, topical therapy, psoriasis, ttop

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