Patterns of dosage regimen instructions regarding topical medicines: how is the information perceived by patients?

BACKGROUND: The communication of dosage regimen instructions by physicians is of utmost importance on treatment adherence. Few studies until now have approached the topical treatment adherence subject. OBJECTIVE: This study aims the characterization of dosage regimen instructions given by physicians and the assessment of chronic dermatological patients' perception regarding these instructions. METHODS: Two instruments one for physicians (PHYSDOSAGE) and one for patients (PATIENTDOSAGE) were developed and applied in a cross-sectional, descriptive and exploratory study to two independent samples composed by 91 physicians and 43 patients. RESULTS: Most of physicians reported to provide dosage regimen instructions. When cross checking information from both studied samples, physicians and patients, it was concluded that physicians reported to provide more frequently oral and written treatment instructions, e.g. electronic prescription, than patients reported having received it. Also, physicians claimed to often provide information about the duration of treatment and the frequency of topical medicines' application, which was not acknowledged by patients. CONCLUSIONS: Contradictory results were found between the physicians' information input and the patients' perception about dosage regimen instructions provided during the consultation. These findings could negatively influence the treatment adherence and the clinical outcomes. Thus, it is of paramount importance the implementation of strategies to improve optimal communication of dosage regimen instructions for topical medicines.

Esclerose Múltipla: duas apresentações clínicas, uma só doença! / Multiple Sclerosis: two clinical presentations, a single disease! / Esclerosis múltiple: dos presentaciones clínicas, una sola enfermedad!

Objetivo: o presente relato de caso pretende demonstrar a diversidade de apresentações clínicas, a evolução dos sintomas e o papel do médico da atenção primária no diagnóstico e seguimento de pacientes com esclerose múltipla e seus familiares. Descrição dos casos: duas mulheres, de 31 e 28 anos, caucasianas, inseridas em famílias nucleares (fases IV e II do ciclo de Duvall, respectivamente) pertencentes à classe média de Graffar. A primeira inicia um quadro insidioso de parestesias das mãos com melhoria em 2 meses. Passado um ano, apresenta-se com dificuldade em elevar as pálpebras e desequilíbrio marcado. A segunda apresenta diminuição súbita da acuidade visual à direita, tendo sido diagnosticada uma neurite óptica. Ambas foram diagnosticadas com esclerose múltipla. Conclusão: a esclerose múltipla é uma doença inflamatória crônica, desmielinizante e degenerativa do sistema nervoso central, que se revela de forma heterogênea. Torna-se importante ao médico de família saber como lidar com as incertezas diagnósticas.

Objective: this case report aims to demonstrate the diversity of clinical presentations, the symptoms evolution and the role of the primary care physician in the diagnosis and management of patients with multiple sclerosis, and their families. Case descriptions: two women, 31 and 28 years old, Caucasian, inserted within nuclear families (phases II and IV of the Duvall' cycle, respectively) belonging to the middle class of Graffar. The first one starts an insidious symptom of paraesthesia of the hands with improvement in 2 months. Within a year, she presents with difficulty raising the eyelids and marked imbalance. The second one presents sudden loss of visual acuity on the right, having been diagnosed with optic neuritis. Both were diagnosed with multiple sclerosis. Conclusion: multiple sclerosis is a chronic inflammatory, degenerative and demyelinating disease of the central nervous system that manifests heterogeneously. It is important for the family doctor to know how to deal with diagnostic uncertainties.

Objetivo: el presente reporte de caso tiene como objetivo demostrar la diversidad de presentaciones clínicas, la evolución de los síntomas y el rol del médico de atención primaria en el diagnóstico y manejo de pacientes con esclerosis múltiple y sus familiares. Descripción de los casos: dos mujeres, 31 y 28 años de edad, de raza caucásica, insertados en las familias nucleares (fases II y IV del Ciclo de Duvall, respectivamente) que pertenecen a la clase media Graffar. La primera inicia con síntomas insidiosos de parestesias de las manos, con una mejoría en 2 meses. Dentro de un año, se presenta con dificultad para levantar los párpados y marcado desequilibrio. La segunda presenta pérdida súbita de la agudeza visual a la derecha y fue diagnosticado con neuritis óptica. Ambas fueron diagnosticadas con esclerosis múltiple. Conclusión: la esclerosis múltiple es una enfermedad inflamatoria crónica, degenerativa del sistema nervioso central y desmielinizante, que se revela heterogéneamente. Es importante para el médico familiar conocer las incertidumbres diagnósticas.