title: Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance.
abstract: OBJECTIVE
  To examine factors associated with compliance with dermatologic treatment.
  
  
  METHODS
  Longitudinal study. Quality of life and psychological well-being were measured before the dermatologic visit with a self-completed questionnaire. Telephone interviews were performed 3 days and 4 weeks after the visit to evaluate patient satisfaction and medication adherence, respectively.
  
  
  METHODS
  Outpatient clinics of a large dermatologic hospital in Rome, Italy.
  
  
  METHODS
  A total of 1389 outpatients were contacted and 722 (52%) agreed to participate. Among them, 424 responded to the inclusion criteria and were enrolled in the study. Of these, 396 (93%) completed the telephone interviews.
  
  
  METHODS
  Self-reported compliance with dermatologic treatment.
  
  
  RESULTS
  The dermatologists' prescriptions were not exactly followed by 44% of patients. In multiple logistic regression analysis, treatment adherence was strongly associated with complete satisfaction. Poor quality of life on the emotions scale (indicating mainly high levels of shame and embarrassment) was also associated with medication adherence. On the contrary, a strong negative association was observed between psychiatric morbidity and compliance.
  
  
  CONCLUSIONS
  This is the first longitudinal study on dermatologic patients showing that dissatisfaction with care and psychiatric morbidity are significantly and independently associated with poor medication adherence. To improve medication adherence, particular attention should be dedicated to the physician's interpersonal skills, which emerged as a major component of patient satisfaction. Moreover, our results highlight the need for a timely identification and appropriate management of psychiatric disorders in everyday dermatologic practice.
authors.affiliation: Health Care Quality Research Unit, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Renzi
authors.forename: Angelo
authors.initials: A
authors.lastname: Picardi
authors.forename: Damiano
authors.initials: D
authors.lastname: Abeni
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Agostini
authors.forename: Giannandrea
authors.initials: G
authors.lastname: Baliva
authors.forename: Paolo
authors.initials: P
authors.lastname: Pasquini
authors.forename: Pietro
authors.initials: P
authors.lastname: Puddu
authors.forename: Mario
authors.initials: M
authors.lastname: Braga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004644:Emotions; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology*; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D011788:Quality of Life; D012871:Skin Diseases / Q000188:drug therapy* / Q000523:psychology*; D011795:Surveys and Questionnaires