Assessing adherence factors in patients under topical treatment: development of the Topical Therapy Adherence Questionnaire (TTAQ)

Ina Zschocke, Ulrich Mrowietz, Annett Lotzin, Eleni Karakasili, Kristian Reich, Ina Zschocke, Ulrich Mrowietz, Annett Lotzin, Eleni Karakasili, Kristian Reich

Abstract

Medication adherence rates strongly depend on favorable disease outcomes. It is known that medication adherence rates are lower for topical treatment than for systemic treatment. However, to date no validated instrument for the assessment of adherence factors in topical treatment is available. The aim of this study was to develop a new questionnaire to assess adherence risk factors in topical treatment. The development of the Topical Therapy Adherence Questionnaire (TTAQ) and Patient Preference Questionnaire (PPQ) was based on a systematic literature review, and qualitative patient focus interviews and expert focus groups' input. The psychometric properties and comprehensibility of the TTAQ and PPQ were assessed in a feasibility study with 59 psoriasis patients. Our first preliminary results indicate that the TTAQ and PPQ are psychometrically sound and reliable measures for the assessment of factors influencing topical treatment adherence. The questionnaires are currently being further developed and various parameters (e.g., time point of assessment) are currently being tested in an exploratory pilot study with ca. 2,000 psoriasis patients receiving topical treatment in a European clinical trial. The use of the final versions of TTAQ and PPQ in clinical practice may facilitate the early identification of specific non-adherence factors in patients under topical treatment, which could enable designing and applying adherence-enhancing interventions according to the patient's individual needs.

Figures

Fig. 1
Fig. 1
Development steps of the TTAQ and PPQ questionnaires

References

    1. Ashcroft DM, Li Wan PA, Williams HC, Griffiths CE. Quality of life measures in psoriasis: a critical appraisal of their quality. J Clin Pharm Ther. 1998;23:391–398. doi: 10.1046/j.1365-2710.1998.00181.x.
    1. Atkinson MJ, Sinha A, Hass SL, Colman SS, Kumar RN, Brod M, Rowland CR. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes. 2004;2:12. doi: 10.1186/1477-7525-2-12.
    1. Augustin M, Dieterle W, Zschocke I, Brill C, Trefzer D, Peschen M, Schopf E, Vanscheidt W. Development and validation of a disease-specific questionnaire on the quality of life of patients with chronic venous insufficiency. Vasa. 1997;26:291–301.
    1. Augustin M, Holland B, Dartsch D, Langenbruch A, Radtke MA. Adherence in the treatment of psoriasis: a systematic review. Dermatology. 2011;222:363–374. doi: 10.1159/000329026.
    1. Augustin M, Lange S, Wenninger K, Seidenglanz K, Amon U, Zschocke I. Validation of a comprehensive Freiburg Life Quality Assessment (FLQA) core questionnaire and development of a threshold system. Eur J Dermatol. 2004;14:107–113.
    1. Augustin M, Radtke MA, Zschocke I, Blome C, Behechtnejad J, Schafer I, Reusch M, Mielke V, Rustenbach SJ (2009) The patient benefit index: a novel approach in patient-defined outcomes measurement for skin diseases. Arch Dermatol Res 301:561–571
    1. Augustin M, Wenninger K, Amon U, Schroth MJ, Kuster W, Chren M, Kupfer J, Gieler U. German adaptation of the Skindex-29 questionnaire on quality of life in dermatology: validation and clinical results. Dermatology. 2004;209:14–20. doi: 10.1159/000078581.
    1. Barton GR, Hodgekins J, Mugford M, Jones PB, Croudace T, Fowler D. Measuring the benefits of treatment for psychosis: validity and responsiveness of the EQ-5D. Br J Psychiatry. 2009;195:170–177. doi: 10.1192/bjp.bp.108.057380.
    1. Bewley A, Page B. Maximizing patient adherence for optimal outcomes in psoriasis. J Eur Acad Dermatol Venereol. 2011;25:9–14. doi: 10.1111/j.1468-3083.2011.04060.x.
    1. Brawley LR, Culos-Reed SN. Studying adherence to therapeutic regimens: overview, theories, recommendations. Control Clin Trials. 2000;21:156S–163S. doi: 10.1016/S0197-2456(00)00073-8.
    1. Bronsard V, Paul C, Prey S, Puzenat E, Gourraud PA, Aractingi S, Aubin F, Bagot M, Cribier B, Joly P, Jullien D, Le MM, Richard-Lallemand MA, Ortonne JP. What are the best outcome measures for assessing quality of life in plaque type psoriasis? A systematic review of the literature. J Eur Acad Dermatol Venereol. 2010;24(Suppl 2):17–22. doi: 10.1111/j.1468-3083.2009.03563.x.
    1. Brown KK, Wingfield ER, Kimball AB. Determining the relative importance of patient motivations for nonadherence to topical corticosteroid therapy in psoriasis. J Am Acad Dermatol. 2006;55:607–613. doi: 10.1016/j.jaad.2005.12.021.
    1. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86:304–314. doi: 10.4065/mcp.2010.0575.
    1. Bryant LJ. Medicines adherence–evidence for any intervention is disappointing. J Prim Health Care. 2011;3:240–243.
    1. Butler RJ, Davis TK, Johnson WG, Gardner HH. Effects of nonadherence with prescription drugs among older adults. Am J Manag Care. 2011;17:153–160.
    1. Dimatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40:794–811. doi: 10.1097/00005650-200209000-00009.
    1. Dreno B, Thiboutot D, Gollnick H, Finlay AY, Layton A, Leyden JJ, Leutenegger E, Perez M. Large-scale worldwide observational study of adherence with acne therapy. Int J Dermatol. 2010;49:448–456. doi: 10.1111/j.1365-4632.2010.04416.x.
    1. Epstein RS. Medication adherence: hope for improvement? Mayo Clin Proc. 2011;86:268–270. doi: 10.4065/mcp.2011.0123.
    1. Ersser SJ, Cowdell FC, Latter SM, Healy E. Self-management experiences in adults with mild-moderate psoriasis: an exploratory study and implications for improved support. Br J Dermatol. 2010;163:1044–1049. doi: 10.1111/j.1365-2133.2010.09916.x.
    1. Feldman SR, Camacho FT, Krejci-Manwaring J, Carroll CL, Balkrishnan R. Adherence to topical therapy increases around the time of office visits. J Am Acad Dermatol. 2007;57:81–83. doi: 10.1016/j.jaad.2007.04.005.
    1. Feldman SR, Horn EJ, Balkrishnan R, Basra MK, Finlay AY, McCoy D, Menter A, van de Kerkhof PC. Psoriasis: improving adherence to topical therapy. J Am Acad Dermatol. 2008;59:1009–1016. doi: 10.1016/j.jaad.2008.08.028.
    1. Finlay AY, Kelly SE. Psoriasis–an index of disability. Clin Exp Dermatol. 1987;12:8–11. doi: 10.1111/j.1365-2230.1987.tb01844.x.
    1. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)––a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210–216. doi: 10.1111/j.1365-2230.1994.tb01167.x.
    1. Flowers B, Wand M, Piltz-Seymour J, Berke SJ, Day D, Teague J, Smoot TM, Landry TA, Bergamini MV, Mallick S. Patients’ and physicians’ perceptions of the travoprost dosing aid: an open-label, multicenter study of adherence with prostaglandin analogue therapy for open-angle glaucoma or ocular hypertension. Clin Ther. 2006;28:1803–1811. doi: 10.1016/j.clinthera.2006.11.001.
    1. Greenlaw SM, Yentzer BA, O’Neill JL, Balkrishnan R, Feldman SR. Assessing adherence to dermatology treatments: a review of self-report and electronic measures. Skin Res Technol. 2010;16:253–258. doi: 10.1111/j.1600-0846.2010.00431.x.
    1. Gupta G, Mallefet P, Kress DW, Sergeant A. Adherence to topical dermatological therapy: lessons from oral drug treatment. Br J Dermatol. 2009;161:221–227. doi: 10.1111/j.1365-2133.2009.09253.x.
    1. Hodari KT, Nanton JR, Carroll CL, Feldman SR, Balkrishnan R. Adherence in dermatology: a review of the last 20 years. J Dermatol Treat. 2006;17:136–142. doi: 10.1080/09546630600688515.
    1. Hovstadius B, Petersson G. Non-adherence to drug therapy and drug acquisition costs in a national population––a patient-based register study. BMC Health Serv Res. 2011;11:326. doi: 10.1186/1472-6963-11-326.
    1. Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008;31:213–224. doi: 10.1007/s10865-007-9147-y.
    1. Jank S, Bertsche T, Schellberg D, Herzog W, Haefeli WE. The A14-scale: development and evaluation of a questionnaire for assessment of adherence and individual barriers. Pharm World Sci. 2009;31:426–431. doi: 10.1007/s11096-009-9296-x.
    1. Kjellgren KI, Ring L, Lindblad A, Maroti M, Serup J. To follow dermatological treatment regimens––patients’ and providers’ views. Acta Derm Venereol. 2004;84:445–450. doi: 10.1080/00015550410020403.
    1. Krejci-Manwaring J, Tusa MG, Carroll C, Camacho F, Kaur M, Carr D, Fleischer AB, Jr, Balkrishnan R, Feldman SR. Stealth monitoring of adherence to topical medication: adherence is very poor in children with atopic dermatitis. J Am Acad Dermatol. 2007;56:211–216. doi: 10.1016/j.jaad.2006.05.073.
    1. Lienert G (1969) Testaufbau und Testanalyse. Verlag Julius Beltz, Weinheim, Berlin, Basel
    1. Martin LR, Williams SL, Haskard KB, Dimatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1:189–199.
    1. Matsui D. Strategies to measure and improve patient adherence in clinical trials. Pharm Med. 2009;23:289–297. doi: 10.1007/BF03256784.
    1. McKenna SP, Cook SA, Whalley D, Doward LC, Richards HL, Griffiths CE, Van AD. Development of the PSORIQoL, a psoriasis-specific measure of quality of life designed for use in clinical practice and trials. Br J Dermatol. 2003;149:323–331. doi: 10.1046/j.1365-2133.2003.05492.x.
    1. Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, Bouter LM, de Vet HC. Protocol of the COSMIN study: COnsensus-based standards for the selection of health measurement INstruments. BMC Med Res Methodol. 2006;6:2. doi: 10.1186/1471-2288-6-2.
    1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–497. doi: 10.1056/NEJMra050100.
    1. Picardi A, Pasquini P. Toward a biopsychosocial approach to skin diseases. Adv Psychosom Med. 2007;28:109–126. doi: 10.1159/000106800.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–343. doi: 10.3109/07853890109002087.
    1. Renzi C, Picardi A, Abeni D, Agostini E, Baliva G, Pasquini P, Puddu P, Braga M. Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. Arch Dermatol. 2002;138:337–342. doi: 10.1001/archderm.138.3.337.
    1. Ribera M, Dauden E, Puig L, Briones VG, Herranz JM, Bordas X, Vanaclocha F. Design and validation of a questionnaire to measure treatment satisfaction in patients with moderate-to-severe psoriasis: the NEODERMA study. Actas Dermo-Sifiliográficas. 2011;102:28–38.
    1. Sabaté E (2003) Adherence to long-term therapies––evidence for action, WHO. . Accessed 16 Jan 2014. WHO1-211
    1. Schmidt J, Lamprecht F, Wittmann WW. Satisfaction with inpatient management. Development of a questionnaire and initial validity studies. Psychother Psychosom Med Psychol. 1989;39:248–255.
    1. Storm A, Andersen SE, Benfeldt E, Serup J. One in 3 prescriptions are never redeemed: primary nonadherence in an outpatient clinic. J Am Acad Dermatol. 2008;59:27–33. doi: 10.1016/j.jaad.2008.03.045.
    1. Zschocke I, Seidenglanz K, Lange S, Schiffler A, Amon U. Validation and clinical results of the FLQA-d, a quality of life questionnaire for patients with chronic skin diseases. Dermatol Psychosom. 2000;1:12–17. doi: 10.1159/000017503.

Source: PubMed

3
Subscribe