Patients comfortable with e-visits to manage acne treatment use

Electronic doctors' visits may be a feasible way to cut down on the burden for patients needing monthly dermatology appointments for acne medication, suggests a small U.S. study.

Users of isotrentinoin, who are required to check in with the doctor every month, said in surveys that so-called e-visits would likely reduce their missed time at work or school by two to three hours every month. But most also said they wouldn't be willing to pay much out of pocket for that convenience.

"I think electronic visits are feasible in the setting of isotretinoin use in terms of safety and patient and caregiver comfort with the safety of those visits," said senior author Dr. Timothy Patton, of the University of Pittsburgh.

Isotretinoin, sold in the U.S. as Accutane by Roche (generic brands include Sotret, Claravis, Amnesteem), is used to treat severe acne. The pill is known for its serious side effects, including bowel problems, mental health issues and an increased likelihood of severe birth defects.

Due to such risks, the U.S. Food and Drug Administration requires doctors, pharmacists and patients involved with the medication to register on a website for the iPLEDGE Program (www.ipledgeprogram.com). Doctors are also only allowed to prescribe the medication for one month at a time.

"IPLEDGE doesn't require the patient to come in, but that's kind of the reality of it," Patton told Reuters Health.

At these monthly visits, doctors counsel patients about birth control, check for side effects and perform pregnancy tests on women before issuing a new prescription.

To evaluate the burden of monthly office visits on patients, the researchers examined data collected in mid-2014 from surveys of 62 adult users and 43 caregivers of patients under age 18.

The participants were also asked about how receptive they would be to some sort of e-visit to perform their monthly checkup for isotretinoin.

Overall, the majority of participants said it took less than a half hour to get to their doctors' offices. The majority also said they missed school or work for the visits, and e-visits would cut down on that missed time.

Participants estimated that e-visits would save about two hours of missed work and three hours of missed school each month, according to the results in JAMA Dermatology.

About 69 percent of patients and 58 percent of caregivers said they weren't concerned by the safety of e-visits. About 16 percent of patients and about 21 percent of caregivers were unsure, and the rest were concerned about the safety of the telemedicine alternative.

Researchers also asked participants what they would be willing to pay out of pocket for such visits and found the average response was $25.

The study authors point out that the cost of time missed from work or school for patients worked out to about $32 to $42, depending on income. And the average cost of an e-visit in the authors' area was $49 to $59. So, they conclude, this alternative might not be financially feasible for doctors if patients aren't willing to pay for it.

Doctors, patients and the FDA need to assess the burdens of iPLEDGE in their "ongoing dialogue" about the program's "evolution," the study team writes.

"I love monitoring my patients via the live interactive manner, because it's great," said Dr. Marie Leger, a dermatologist at NYU Langone Medical Center in New York City, who wasn't involved in the study.

"I feel I can do a really good and thorough job through that technology to make sure the patient is taking their medications appropriately," Leger said.

Her patients in Kentucky drive to nearby centers with special telemedicine equipment, which allows her to examine them remotely and order blood tests.

She hasn't used so-called store-and-forward technology, which allows doctors to examine pictures from devices like smartphones of patients' skin conditions, Leger noted.

Patton said e-visits are feasible, but patients would always likely have the option to meet with their doctors in person.

"I think it could be a really great thing," Leger said. "For my patients that I take care of in Kentucky, where it takes so long to get an appointment, it's fantastic."