A Scientific and Ethical Approach To In-Office Skincare Retail – Part 5

In this five-part series, I have discussed the essential characteristics of developing customized skincare routines for patients to increase efficacy and outcomes, as well as reduce side effects. I’ve also outlined the features of the Skin Type Solutions System, which helps doctors assess the Baumann Skin Type® of each patient without requiring an additional time commitment from doctors or staff members.

In this last installment, I’ll discuss encouraging compliance and successfully selling skincare products in your practice.

Patient Compliance

Studies show that in dermatology patients compliance is very poor.  Most studies have focused on acne^[1] and psoriasis^[2] therapies.  These studies have demonstrated that in many cases patients usage of topical medications decreases over time^[3] and over 95% of patients underdose their medications^[4] and 1 in 3 prescriptions are never even redeemed!^[5] Obviously, patients will not get better if they do not use their skincare and topical medications. We need to take measures to try and motivate our patients to be compliant.

Encouraging Compliance

Sending patients home with new products and telling them how to use them isn’t always enough. I recommend scheduling a follow-up visit in four weeks at the end of their initial appointment, so you can check on their progress and ensure compliance. It is imperative to emphasize the importance of this follow-up visit.

Feldman showed in 2007^[6] that patients are more likely to use their products in the days before and the days after their visit to their dermatologist.  He suggested that more frequent office visits would boost compliance. For this reason, I suggest touching base with your patients about their skincare at least every 4 weeks.  While it is ideal to do this in person, I am studying the ability of a mobile app to encourage patients to be compliant. Certainly, the most important predictor of compliance is whether or not the patient purchases the products or prescription medications.

Patient Education Encourages Compliance

Most dermatologists only have 3-5 minutes per patient, so streamlining the process of designing a treatment plan and educating the patient and recruiting your staff to help educate patients is crucial.  In order to maximally encourage patient compliance, the following must to occur:

1. The patient needs to understand what medications and products to use.
2. The patient must understand when and how to use the products.
3. The patient must understand what order to use the products in (Step 1, Step 2, etc).
4. The patient must purchase the products (From you or elsewhere).
5. The patient must tell you if they do not purchase the products (Insurance will not cover, too expensive, could not find them, etc.).
6. The patient must use the products consistently.
7. The patients must tell you if they do not use the products (Too busy, did not have them on their trip, etc.).
8. The patient must report any side effects so you can adjust the therapy accordingly.

Why Does Non Compliance Occur?

There are many common things that get in the way of compliance. Here are a few of the reasons that patients are not compliant in dermatology:

1. Failure to purchase the products- This is much more common than you think.  Offering clear advice on why the products are important and what to buy is critical. Retailing the products in your office makes it more convenient and likely that they will purchase their recommended regimen.
2. Lack of motivation- Patients need to be motivated to use their products consistently every day. Values and attitudes of the patient and doctor and individual factors play a role. The physician and staff’s attitudes about the efficacy of the products directly affects the confidence the patient feels about the products and the necessity of their use. For this reason the physician should take the proper steps to ensure that they are prescribing efficacious products and educate their staff on the science. The patients will feel the confidence and this may translate into improved compliance.^[7]
3. Occurrence of a side effect -The patient does not know how to properly handle the side effect so they stop using the product. If you prescribed a retinoid, for example, patients may experience irritation and stop using it. This usually occurs in the first 2 weeks of using the product.  Planning a follow up visit at 2-4 weeks can encourage compliance.
4. Impatience with results- Patients often have unrealistic ideas about how quickly the products will improve their skin- perhaps from seeing too many misleading ads claiming that their “wrinkles will improve in four weeks.” Educating the patients on when they will see results can help. If you have an imaging system, baseline and follow-up photos objectively demonstrate improvement and keep them enthusiastic and vigilant.  The imaging systems can also detect noncompliance so that you can discuss with your patients why they are not using the prescribed regimen. I have found that four weeks is an ideal timeframe because patients tend to lose interest at that point.
   

Selling Skincare Products in Your Practice May Improve Compliance

In 2005, I surveyed my patients, and 100 percent of them wanted me to sell products so they could feel certain that they were purchasing the right products for their needs.  They also wanted the convenience.  Most patients are eager to get started on their regimen and you need to catch them at the most open minded time when motivation is highest just after the office visit. After years of retailing skincare in my office and advising my over 500,000 online followers, I have found that patients want “medical advice on skincare®.” Cosmeceutical science is so complicated now, as evidenced by this five-part series, that you really need to be specially trained to understand the science. Patients need to be able to rely on their dermatologist for accurate skincare advice. You are the expert.  You have had at least 12 years of training to get where you are, and you should strengthen your expertise on skincare to protect your patients from less ethical skincare sellers. As a medical practitioner, you can make educated, ethical and scientific choices about skincare products and help patients avoid products and ingredients that don’t work or will cause harm to their skin.

I hope the skincare retail essentials that I’ve outlined over the past several weeks has given you more confidence to design skincare regimens for your patients. I am always happy to share my knowledge and answer questions. To learn more about cosmeceutical science or my expert skincare diagnostic system please visit STSFranchise.com or feel free to email me at [email protected].  You can also follow me on LinkedIn or LeslieBaumannMD.com.  I also have a private Instagram account for training dermatology residents @LeslieBaumannMD.

Missed Part 4 of this series? Check it out here!

^[1] Anderson KL, Dothard, EH, Huang KE, et al. Frequency of primary nonadherence to acne treatment. JAMA Dermatol. 2015 Jun;151(6);623-6.

^[2] Ali, S. M., Brodell, R. T., Balkrishnan, R., & Feldman, S. R. (2007). Poor adherence to treatments: a fundamental principle of dermatology. Archives of Dermatology, 143(7), 912-915.

^[3] Carroll, C. L., Feldman, S. R., Camacho, F. T., Manuel, J. C., & Balkrishnan, R. (2004). Adherence to topical therapy decreases during the course of an 8-week psoriasis clinical trial: commonly used methods of measuring adherence to topical therapy overestimate actual use. JAAD, 51(2), 212-216.

^[4] Storm, A., Benfeldt, E., Andersen, S. E., & Serup, J. (2008). A prospective study of patient adherence to topical treatments: 95% of patients underdose. Journal of the American Academy of Dermatology, 59(6), 975-980.

^[5] Storm, A., Andersen, S. E., Benfeldt, E., & Serup, J. (2008). One in 3 prescriptions are never redeemed: primary nonadherence in an outpatient clinic. Journal of the american academy of dermatology, 59(1), 27-33.

^[6] Feldman, Steven R., et al. “Adherence to topical therapy increases around the time of office visits.” JAAD 57.1 (2007): 81-83.

^[7] Taube, K. M. (2016). Patient–doctor relationship in dermatology: from compliance to concordance. Acta dermato-venereologica, 96(217), 25-29.