Addressing Issues in Isotretinoin Treatment Plan Adherence: An Evidence-Based Practice Improvement Project

BACKGROUND: Isotretinoin is strictly regulated by the federal government due to its teratogenicity. In the United States, a risk management program called iPLEDGE was developed to prevent pregnancy in patients undergoing isotretinoin therapy. iPLEDGE regulations stipulate that patients must see their provider and pick up their prescriptions within a specific time frame. Current evidence suggests that adherence to isotretinoin treatment plans is a global issue.

LOCAL PROBLEM: At the project site, a dermatology clinic in Knoxville, Tennessee, patients often fail to obtain their prescriptions or return to the clinic within the required timeframe. This project was developed to address adherence issues by improving the patient education process. This project aims to increase the rate of 30-day follow-ups in patients being prescribed isotretinoin by 25% within three months of implementation.

METHODS: The Evidence-Based Practice Improvement (EBPI) model was used as the framework to guide this project. Project team members collaborated to design a project focused on patient education through the use of an infographic. Plan-Do-Study-Act (PDSA) cycles were used to develop the infographic and measure small tests of change throughout the implementation process.

INTERVENTIONS: The educational infographic was utilized alongside iPLEDGE educational materials. Once project implementation began, staff nurses utilized the infographic to educate patients beginning isotretinoin therapy.

RESULTS: 100% of patients in the post-implementation group received the infographic and scheduled their first follow-up appointment before leaving the clinic after their initial visit. 96% of patients in the pre-implementation group and 95% of patients in the post-implementation group returned to the clinic for their follow-up appointments within the required timeframe.

CONCLUSIONS: There was no statistically significant change in the 30-day follow-up rate; however, clinical significance was evident through the consistent use of the infographic, appointment scheduling, and the standardization of the patient education process. Additional projects are needed to further explore and address isotretinoin treatment adherence.