Short summary

Psoriasis is a chronic disease affecting 2-4 % of the adult western population. Topical corticosteroids and corticosteroid combinations are first-line prescribed treatments. Medical nonadherence is a problem, resulting in lack of treatment effect. Only a few interventions have proven successful in improving medical nonadherence in chronic diseases. We aim to test if a multifaceted intervention (designed to support patient behavior by education, motivation, and measurement) delivered in an app for smartphones can improve medical adherence to a topical corticosteroid/calcipotriol combination prescribed for patients diagnosed with psoriasis.

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Rationale

Psoriasis is a chronic disease affecting 2-4 % of the Western population. Prescribed topical corticosteroids and corticosteroid combinations constitute the first line of treatment of psoriasis and are considered safe and effective, when used as prescribed. For a satisfactory treatment outcome, correct application of prescribed topical medication is necessary. Medical nonadherence in patients with psoriasis is a problem in clinical settings. Reasons for medical nonadherence are multifactorial and can be grouped into social/economic, health system related, disease-related, treatment-related, and patient-related determinants. From other chronic diseases, only a few trials using multiple interventions have proven successful in improving medical adherence. The interventions improved medical adherence both by educating and motivating and at the same time monitoring the use of prescribed treatments. The interventions were expensive and after study cessation they were not implemented in the clinic.

In an era with an increasing use a smartphones, several patient-supporting apps have been designed and include multiple interventions with the aim of improving medical adherence.

This study has been planned to test if an intervention delivered in an app for smartphones can significantly improve medical adherence in psoriasis patients treated with a topical corticosteroid/calcipotriol preparation.

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Description of the cohort

Inclusion: Patients from age 18-75 years, diagnosed with mild to moderate psoriasis who are candidates for a topical corticosteroid/calcipotriol preparation. Access to and user skills in email and smartphones are mandatory.

Exclusion: Prior users of the app we wish to study.

Recruitment for study: Outpatient clinic at Department of Dermatology and Allergy Centre, Odense University Hospital and by advertisements.

Randomization: Block randomization.

Data and biological material

Baseline data at inclusion in study:

Physician-reported baseline: Estimates amount of preparation the patient needs to apply in a 4-week study period.

Patient-reported in online questionnaires:  Socio-demographic data, prior and former use of medication, years since diagnosed with psoriasis.

Measurement rate of medical adherence - monitoring week 0-4: no. treatment episodes in a treatment period / expected no. treatment episodes in a treatment period.

Secondary Outcome Measures: Baseline, week 4, 8, and 26: Dermatology Life Quality Index (DLQI) and Lattice-System Psoriasis Global Assessment (LS-PGA).

Collaborating researchers and departments

Department of Dermatology and Allergy Centre, Odense University Hospital

Centre for Innovative Medical Technology, Institute of Clinical Research, University of Southern Denmark & Dermatological Investigations Scandinavia

• PhD-student Mathias Tiedemann Svendsen
• Professor Klaus Ejner Andersen

Department of Dermatology and Allergy Centre, Odense University Hospital & Dermatological Investigations Scandinavia

• Clinical Associate Professor Flemming Andersen