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IMPORTANCE Primary nonadherence with acne medications is high but commonly underreported to prescribing physicians.OBJECTIVES To describe patient experiences with primary nonadherence to medications for acne and to identify physician-level factors that may improve adherence in this population. DESIGN, SETTING, AND PARTICIPANTSA qualitative analysis was conducted from structured interviews with patients reporting nonadherence with acne medications at a large academic health system in the Philadelphia, Pennsylvania, area. Three hundred eighty-five patients from 4 dermatology practices in the Philadelphia area were screened for primary nonadherence with a newly prescribed acne medication. Twenty-six patients participated in structured interviews conducted between November 30, 2016, and January 31, 2017.MAIN OUTCOMES AND MEASURES Thematic analysis of the transcripts was performed to detect recurrent themes and divergent ideas with a focus on modifiable physician-level factors that might improve primary adherence to medications for acne.RESULTS Participants (19 [73%] women, 6 [23%] aged <26 years, 15 [58%] aged 26-40 years, and 5 [19%] aged >40 years) reported cost as the major barrier to initiating therapy. Despite anticipating this barrier, they rarely brought up costs with physicians during the initial visit and generally did not expect their physician to be knowledgeable in this area. Although patients experienced inconvenience and frustration when unable to fill their prescriptions, this experience did not appear to negatively affect their satisfaction with the prescribing physician. Nevertheless, warning patients that the preferred medication may be expensive, having a plan of action if patients were unable to fill the prescription, and securing the patient's commitment to the plan were described as actions that the physicians could take to improve primary adherence.CONCLUSIONS AND RELEVANCE Physician-level interventions to improve primary adherence to medications for acne may have an impact on nonadherence with costly medications, although they may not affect patient satisfaction with the prescribing physician.

Key Points Question What is the role of patient preference in racial disparities in opioid prescribing for patients with acute pain, and does providing clinicians with additional data about their patients mitigate disparities? Findings In this secondary analysis of 1012 patients with acute pain who were recruited for a multicenter randomized clinical trial, Black patients were less likely than White patients to receive a prescription for opioids, regardless of their treatment preference. These disparities were not mitigated by providing clinicians with additional data about their patients’ preferences and risks. Meaning This study’s findings suggest that differences in patient preference do not explain racial disparities in opioid prescribing; further research is needed to assess the factors associated with these disparities.

Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition. Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients between 18 and 70 years of age presenting with kidney stone or musculoskeletal back pain. Participants were randomly assigned to 1 of 3 risk communication strategies: (1) a personalized probabilistic risk visual aid, (2) a visual aid and a video narrative, or 3) general risk information. The primary outcomes were accuracy of risk recall, reported opioid use, and treatment preference at time of discharge. Results. A total of 1301 participants were enrolled between June 2017 and August 2019. There was no difference in risk recall at 14 days between the narrative and probabilistic groups (43.7% vs 38.8%; absolute risk reduction = 4.9%; 95% confidence interval [CI] = −2.98, 12.75). The narrative group had lower rates of preference for opioids at discharge than the general risk information group (25.9% vs 33.0%; difference = 7.1%; 95% CI = 0.64, 0.97). There were no differences in reported opioid use at 14 days between the narrative, probabilistic, and general risk groups (10.5%, 10.3%, and 13.3%, respectively; P = .44). Conclusions. An emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall. Trial Registration. Clinical Trials.gov identifier: NCT03134092. (Am J Public Health. 2022;112(S1):S45–S55. https://doi.org/10.2105/AJPH.2021.306511 )