Patient Characteristics Associated With Adherence to Phototherapy
Oh, Susan B.
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BACKGROUND: The therapeutic efficacy of phototherapy is dependent on regular visits over extended time periods. There is concern among dermatologists regarding the feasibility of phototherapy in the face of increasing patient burden in terms of cost and time. However, no studies to date have examined the association between the demographic and clinical features of patients, particularly cost, and their adherence to a phototherapy regimen. Studies of this type are needed to document barriers to access and develop strategies to overcome them. OBJECTIVE: Identify patient demographic and clinical characteristics associated with adherence to prescribed phototherapy regimens (as defined by the number of treatments) and the most common reasons for discontinuation of a prescribed regimen. SETTING, DESIGN, PARTICIPANTS: Cross sectional study of 260 patients who were prescribed phototherapy at the UTSWMC Department of Dermatology Phototherapy Center between 9/1/2011 and 12/31/2013. MAIN OUTCOMES AND MEASURES: Main outcome was total number of completed phototherapy sessions (dependent variable). Independent variables included patient characteristics such as income, commuting distance to the phototherapy center, cost of phototherapy; and demographic and clinical characteristics. RESULTS: Using ordinary least-squares regression analysis, we identified specific patient characteristics associated with adherence. Males completed more treatments when compared with females (p = 0.038). Race also played a role in adherence with Hispanics, Asians and Whites being more adherent than African Americans (p = 0.025). Cost was a major factor predicting adherence (p= 0.0001). Our univariate analysis additionally showed particular diagnoses (vitiligo and mycosis fungoides) and type of phototherapy (NBUVB) were associated with greater adherence (p= .003, p= .009), but these results lost significance in our multivariate analysis. Age, distance, income, type of insurance, and type of phototherapy were not significantly associated with differences in adherence in any of our analyses. CONCLUSION AND RELEVANCE: Cost of phototherapy was the most frequent reason why patients failed to adhere to prescribed phototherapy and the major factor affecting adherence to phototherapy. Given phototherapy is less expensive than many systemic medications used in place of phototherapy, efforts should be undertaken to reduce patient cost burden for phototherapy. Also, as specific patient and disease characteristics were associated with better adherence. providers should be aware of patients at risk for poor adherence and provide counseling to improve the likelihood of successful treatment.