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Cultivating a Compliant Culture
BY MILE BRUJIC, OD
Many of us write prescriptions for ocular medications multiple times a day. We formulate a diagnosis based on the presenting symptoms and examination findings and then select a pharmaceutical agent most appropriate to alleviate those symptoms. The prescriptions we write are specific for the name of the medicine, the number of drops to be used at each dosing, and the number of dosings per day. We will then usually schedule a follow-up visit to determine the efficacy of the therapy prescribed.
The overwhelming majority of the time, we see significant improvement in the condition being treated. This is the direct result of two things: the effectiveness of the products being prescribed; and proper compliance with the therapeutic regimen.
Is there anything we can learn from our success with prescribed regimens for these patients that we could apply to our contact lens-wearing population?
The unfortunate reality is that many of our contact lens wearers are not compliant with their prescribed lens replacement and care regimen. More than 49 percent of patients wear their lenses for longer than they are supposed to (Contact Lens Council Press Release, 2007). Additionally, many lens wearers interchange contact lens care systems without ever consulting their eyecare providers.
An interesting survey of 300 optometrists looked at what contact lens care systems the respondents were recommending (Harris Interactive Survey, 2009). An analysis of actual market share of lens care solutions purchased revealed a significant difference from what practitioners recommended. Figure 1 shows the percentages of solutions recommended by practitioners and what patients actually purchased.
Figure 1. Patients do not always buy the solutions that their practitioners recommend.
What Is Really Happening?
When we prescribe medications, patients usually follow through with the treatment. When we prescribe lens materials, we know what contact lenses they will come in wearing. But when we recommend care systems, we must depend on patients remembering what we recommend and correctly telling us what they use.
Unfortunately, this is often incorrect. Store brand solutions often have packaging that looks very similar to branded solutions. It is difficult to know what solutions are in the different store brand bottles as each will change periodically.
To minimize the discrepancy between what we think our patients are using and what they are actually using, in our practice we ask our lens wearers to bring in their case, care solution, and any other drops that they may be using. This has helped reveal the actual care systems that our patients are using and is certain to do the same in your practice.
This policy also provides insights into how patients are actually utilizing their care systems. Many of our patients reuse the solution that they store their contact lenses in. Unfortunately, 44 percent of patients will top off their contact lens solution (Contact Lens Council, 2007). Additionally, 52 percent of patients simply place contact lenses in the solution without any rub or rinse step (Stone, 2007).
Compliance is certainly an issue that we need to address with our contact lens wearers. We can help change these habits by constantly reinforcing proper compliance habits at every visit.
Reinforcing Lens Care
When communicating the benefits of your care system of choice, highlight attributes of the selected solution in a way that allows patients to easily understand “what's in it for them.” Simply providing a sample of a care system may be enough reason to follow your recommendations for some patients, but not most. What resonates with lens wearers are reasons that help them understand the benefits of utilizing the recommended care systems as directed. For example, describe the recommended care system as one that will minimize their chance of developing comfort issues that may limit contact lens wear. This is something that most lens wearers can certainly relate to.
Writing a prescription for a specific contact lens care system will also help reinforce compliance. Although not a prescription product, this strengthens your recommendation and eliminates any confusion that may exist for patients at the retail counter.
Many contact lens comfort issues and complications can be alleviated by simply returning patients to compliant habits. This includes replacing contact lenses as recommended, utilizing recommended contact lens solutions, and properly cleaning and storing lenses. By learning what lens care systems your patients are truly using and by educating them on proper solutions and care for their lenses, you have the ability to improve compliance rates one patient encounter at a time. CLS
To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #170.
Dr. Brujic is a partner in a multilocation group practice where he sees patients in Bowling Green and Lima, Ohio. He lectures nationally on contemporary topics in eye care. He has received honoraria for either writing, speaking, performing research, or acting in an advisory capacity from Alcon, Ciba, CooperVision, Vistakon, Advanced Vision Research, Aton Pharma, and Inspire Pharmaceuticals.