10 Steps to Improving Contact Lens Compliance
We may never get patients to comply fully with lens care, but we can take measures to help them improve it.
By Carmen F. Castellano, OD, FAAO
Contact lens and solution manufacturers are constantly striving to make products that are safer and easier for our patients to use. Eyecare practitioners are forever interested in safety and efficacy, while recognizing that patients are more likely to comply with convenient and easy-to-use systems of contact lens wear and care. Though the number of contact lens wearers is growing, a significant number of patients continue to drop out of lens wear each year. A good percentage of these individuals may discontinue wearing contact lenses because of noncompliance issues.
Compliance among contact wearers is a multifaceted issue. Proper lens care is essential for safety and success, but so is adherence to prescribed replacement schedules and recommended wearing schedules, as well as regular return visits to the eyecare practitioner. Failure to comply with any or all of these issues may result in significant complications and possibly discontinuation of contact lens wear.
Numerous studies over the years have looked at compliance among contact lens patients, and statistics abound. Following are just a few examples of statistics that have been published in recent years regarding compliance:
- Most healthcare providers say that one-third of patients will follow instructions exactly, one-third will follow some instructions and one-third will not follow instructions at all
- Seventy-four percent of contact lens patients exhibit at least one aspect of noncompliant behavior
- Forty percent to 91 percent of contact lens patients are noncompliant in their recommended care and maintenance regimen
- Though 75 percent of soft contact lenses are prescribed for one-day to two-week replacement, only 25 percent of patients adhere to that schedule. One-fourth of patients stretch the replacement schedule to one month and 23 percent to as long as six months
- Another study showed that 53 percent of patients keep lenses longer than recommended
- Twenty-five percent to 50 percent of patients are noncompliant in some aspect of hygiene. One-fourth of patients don't always wash their hands prior to handling contact lenses and 12 percent never do
- Twenty percent of patients replace their contact lens case yearly while 23 percent of patients never replace their case
- Up to 80 percent of contact lens complications trace back to poor patient compliance with recommended lens care guidelines
- * Five percent of patients use saline only as their primary mode of "disinfection"
- Twenty-nine percent consult their eyecare practitioner every two years
- One study asked patients six questions to assess patient knowledge of contact lens care and safety. Of a possible six out of six correct answers, the mean number of correct responses was 3.74 (62 percent)
As you can see, as hard as practitioners and manufacturers have seemingly tried, their collective efforts have fallen short with regards to patient compliance. They're either not delivering the message adequately or there's a disconnect between practitioner and patient. Perhaps patients don't understand the message, don't grasp the potential consequences of noncompliance or, less likely, they truly don't care about the consequences.
Whatever the reason for this abundance of non-compliance, it's obvious that to ensure patient safety and to minimize contact lens dropouts, practitioners must be diligent in promoting compliance with their patients. Practitioners who simply "dabble" in contact lens care may not be doing enough to emphasize the importance of proper care, wear and follow up. As more and more patients look elsewhere for contact lens replacements, it's easy for practitioners to become frustrated and disillusioned with contact lens practice. Instead, they should embrace the opportunity to provide a level of service that can't be matched outside of a doctor's office.
Patients are usually willing to pay more if they perceive a value for their expenditure. By providing a higher level of service, you can put fun back into contact lens practice and better ensure compliance on the part of your patients. Following are 10 suggestions to help you elevate your service and improve various aspects of contact lens patient compliance.
1 Educate Your Staff and Your Patients
To illicit proper patient compliance, it's critical that you and your staff are reading from the same page. Your staff must understand your philosophy of contact lens fitting, care and follow up so that patients hear the same message, no matter with whom in the office they are speaking. Emphasize the importance of contact lens compliance with patients at every step along the way, from telephone to check out. Use in-office materials to reinforce the importance of recommended lens wear, care and follow up.
My office uses pamphlets and solution displays showing recommended products. Also, each exam room is equipped with an acrylic drawing board to illustrate and emphasize various items for patients. This may provide visual reinforcement when discussing solutions, follow-up visits and illustration of problems such as neovascularization or GPC. The better you educate a patient regarding the potential dangers of noncompliance, the more likely he may be to comply with your recommendations.
2 Put Instructional Videos to Use
With new patients, especially, use in-office videos to discuss proper lens care techniques and recommended care products. Patients can watch/listen while lenses are settling on their eyes. In-office videos show patients in your reception room that you offer quality contact lens care. Lens care videos may be available from manufacturers or you might prefer to customize your own.
These days, DVDs and cassettes are available at a reasonable cost, so consider providing patients with copies so they can review the material and procedures on their own at home until they're proficient at lens care and handling. This may also help to address questions without the need for additional phone calls to your office.
3 Make Time for Personal Instruction
We've all had patients new to our offices who've failed previously with contact lenses solely because they became frustrated with application and removal. In many of these instances, the problems occurred because nobody took the proper time to teach the patient good contact lens handling techniques.
Designate someone from your staff to handle personal lens care instruction. He should do it in a separate area where patients can feel comfortable. The instructor should demonstrate the procedures and then allow the patient to apply and remove lenses on his own. Don't send patients home with contact lenses if they can't demonstrate the ability to handle the lenses satisfactorily in your office. Occasionally, it may be necessary to have the patient return another time before you actually dispense the lenses. We recommend instructing children first alone, and then with a parent present. This way, the child may practice application and removal without feeling pressure and the parent will still know what to do in case of emergency.
You may then provide initial solutions so patients know exactly what you expect -- especially when you place an emphasis on not varying from your recommendation. In addition, it's helpful to offer patients reinstruction if they report any application or removal difficulties during their early follow-up appointments. Sometimes patients may have questions that they wouldn't have known to ask at the initial instruction session.
4 Show Them You Care
A customized instruction manual puts your recommendations in writing and allows for quick patient reference. Use it to describe lens handling procedures, recommended care products, wearing time, replacement schedule and recommended follow-up dates. It's also helpful to include special instructions such as swimming advice or the proper use of makeup with contact lenses. In addition, it's critical to provide a 24-hour phone number so contact lens patients may reach you in the event of an emergency.
5 Review Lens Care at Every Visit
It's helpful to include compliance questions at each contact lens patient's visit to the office. A careful review of wearing time and replacement schedule can help uncover potential problems with lens wear. Ask patients to name the products they're using and to explain how they use them. If the patient is unsure of the name of a product, then ask him to describe the packaging. The patient's rate of contact lens reorder will also indicate whether the patient is complying with your prescribed discard schedule.
In the early days of disposable lenses, experts speculated that the more contact lenses a patient had on hand the more he was likely to use. In reality, this hasn't been the case. A significant number of patients stretch their lens replacement cycle. Discuss their replacement patterns at each visit, and emphasize the risks of noncompliance.
6 Get Their Attention
Some doctors are more comfortable using informed consent than others, but it may be advisable, especially in higher-risk procedures such as extended or continuous wear. At the least, getting a patient's consent helps emphasize the serious nature of the patient's commitment and the potential ramifications of noncompliance.
7 Let Them Read All About It
Besides being an excellent practice-building tool, patient mailings can also serve as an excellent source for promoting patient compliance. Whether you prefer subject-specific mailings or newsletters covering a number of topics, use mailings to emphasize the importance of regular exams as well as proper contact lens care and maintenance. Patients are often inundated and confused by a plethora of advertisements, to say nothing of the myriad of contact lens care products seen on most pharmacy shelves. Periodic reminders in the form of patient mailings can help them sort through the confusion and re-emphasize the importance of staying with your care recommendation.
8 Offer Solutions in Your Office
What better way to enhance lens care compliance than to add a profit center for your practice? Making solutions available in your office may keep patients from experimenting with other brands on a whim. Some practitioners even mail solutions to patients to make the transaction as convenient as possible.
9 Keep Patients Coming Back for More
Making sure patients return to your office on a regular basis can prove healthy for their eyes and for your practice. Greater patient traffic increases possibilities for sales of eye wear, sun wear, contact lenses and solutions. And regular visits may lead you to identify problems early, before they become major issues. Once again, regular encounters provide an opportunity to reiterate the importance of compliance.
Pre-appointment allows the staff to emphasize the importance of regular care while the patient is in the office by giving him a specific date and time to return. A reminder card or a confirmation phone call can prove helpful as the pre-appointed date approaches. However, if you're uncomfortable with pre-appointing, then consider using a reliable recall system. In addition, you can enhance compliance by making sure your staff promptly calls cancellations and no shows for re-appointment.
10 Get Your Patients to Commit
As third parties have become a greater part of optometric practice, some feel that traditional contact lens service agreements aren't as valuable as they once were. We've found the opposite to be true. In fact, a service agreement can still be an excellent tool in managing a successful contact lens practice. Service agreements tie patients to your practice for a full year, making them less likely to shop elsewhere for products or services. Patients are also less likely to put off needed care, which can minimize problems.
Send service agreement renewals in a timely manner and make sure they're easy for patients to understand. Comparing costs of products or services without a service agreement to costs with an agreement is helpful in selling the benefits of such a commitment to a patient because an agreement covers contact lens services and reduces the cost of materials. We've found success by mailing renewals about one month before the expiration date of the patient's current service agreement. If you don't receive a response from the patient, send out a second notice one month later and a third in another month. Our experience has shown that most patients will respond after the first or second mailing.
Improving Compliance Doesn't Take a Genius
Many of these suggestions to improve compliance with contact lens wear and care involve nothing more than common sense and a commitment to provide patients with a high level of service. The more we commit to the contact lens aspects of our practices, the more we can expect patients to commit to proper compliance. One hundred percent compliance may not be possible, but by taking our roles as healthcare providers and educators more seriously, we'll be better able to communicate the importance of proper compliance to our patients.
To obtain references, please visit http://www.clspectrum.com/references.asp and click on document #103.
Dr. Castellano practices at The Koetting Associates, specializing in contact lenses. He currently serves as an adjunct assistant professor at the University of Missouri-St. Louis School of Optometry, and the Department of Ophthalmology and Visual Science at the Washington University School of Medicine. Dr. Castellano is a diplomate in the Section on Cornea and Contact Lenses of the American Academy of Optometry and serves as a chair of the American Optometric Association Contact Lens and Cornea Section.