patient education

MEDICAL MODEL

Creating Contact Lens Compliance

Follow these five tips to get patients to adhere to the prescribed wear and care instructions.

MARK HINTON, ASHEVILLE, N.C.

More than half of contact lens (CL) wearers surveyed are not compliant with their two-week or monthly schedule, says a recent Contact Lens Anterior Eye study. Also, the study reveals “significant” non-compliance with lens care steps and case hygiene. Unfortunately, this is just one of several such studies. As this non-adherence places patients at an increased risk for ocular issues, such as corneal ulcers, that can, in turn, prompt CL drop out, it’s essential eye-care practitioners focus on improving patient compliance.

Here, I provide five tips on how to accomplish this.

1 Show adverse events.

Create a one-page handout that contains photos of non-compliant behavior-caused CL complications, including GPC, corneal infiltrates, erosions, ulcers, etc., and have you or your staff say something similar to:

“Kathy, I want you to understand the importance of following the exact prescribed wear and care schedule. To help illustrate this, these are images of eyes of contact lens patients who said they didn’t think these outcomes would ever happen to them. Some are unable to wear contact lenses again, and others have experienced worse outcomes. This is to inform, not scare you. I imagine you’d like to avoid these types of infections, right?”

A clinical image makes a strong impression, as it enables the patient to actually “see” the likely outcomes of noncompliance vs. just hearing the names and descriptions of the aforementioned conditions.

Engaging the patient is also a crucial component here.

Sometimes, practitioners and staff talk “at” patients rather than making them part of the conversation. Saying, “I imagine you’d like to avoid these types of infections, right?”, “Does that make sense?” and “Is that important to you too?” engages the patient, letting him/her know that he/she plays a primary role in his/her CL success.

2 Provide a support form.

Social science studies reveal people recall less than 10% of what they hear. Given this statistic, provide a support form that includes the prescribed CL, solution, drops (if applicable), care and CL and case replacement times. Make sure the form contains a patient signature line, so he/she can acknowledge understanding of and take responsibility for the information. Also, make sure the patient and practice have a copy of the signed sheet. This is another form of patient engagement. (See “Example Form,” page 25.)

3 Discuss reminder technology.

Inform patients about the various wear and care schedule reminder technologies. To start, Acuminder (www.acuminder.com), from Vistakon, enables patients, regardless of their CL brand, to sign up for free to receive automatic e-mail and/or text messages about when it’s time to change their lenses, purchase new ones and/or schedule an eye appointment. LensAlert (www.lensalert.com), from WatchDog Group, is a timer (in days) that tells patients when to replace their lenses and lens case.

Further, an array of reminder smart phone apps and electronic calendars, the latter accessed via computer and able to sync to smartphones, enable wearers to create CL dates to remember.

4 Prescribe an annual supply.

Many practitioners have found patients are more likely to adhere to their replacement schedule when a fresh CL is readily available. So, prescribe an annual supply of CLs.

To overcome the cost barrier to this step, explain to patients how an annual lens supply decreases their likelihood of CL-induced adverse ocular events. An example script:

“Kathy, Dr. Rossi has prescribed an annual supply. This is because he wants you to have a fresh lens when it’s time for you to ‘toss and replace,’ according to the prescribed replacement schedule. Your tears produce calcium deposits, which attach like glue on the backside of the lenses, harden like little sharp points and can scratch your eye and infect it. As a result, if you wear your lenses past the prescribed replacement schedule, you can develop an infection, and you may be unable to wear CLs for a period of time or permanently. You want to avoid that problem, right? What address would you like me to have your annual supply shipped?”

Also, show patients the “true” cost when factoring in the bulk purchase savings, his/her health insurance and rebates. Reference rebates as a “Savings Certificate” or “Added Savings.” The reason: Consumers become more interested in products that can save them money. Also, make the savings sound extra special and not always available:

It’s possible to overcome the cost barrier associated with an annual supply of CLs.

“Kathy, there’s an added bonus for you today because we’re ordering an annual supply. On occasion, the manufacturer provides a mail-in-savings rebate, and you’re in luck because I have one for you today.”

Scarcity of something desirable often yields great consumer interest.

A caveat: Don’t make rebates the focus when explaining an annual supply’s benefits. The reason: You send the message to patients to search for the best deal when they require a new supply of lenses, say some practitioners.

If your office gives an additional discount for buying the annual supply, say:

“In addition to the mail-in rebate, I’ll give you an instant savings on your contact lenses today too.”

For patients who may question “what if...?” or who want their CL prescription, provide a document called “Reasons Patients Choose Us For Their Contact Lens Provider,” and include your policy on prescription changes before the annual supply is finished, damaged lenses, emergency diagnostic lenses, etc.

If after all this, the patient says, “I’m sorry, but I just can’t afford an annual supply right now,” reply:

“I may be able to spread your total cost over six months, interest free through an option called CareCredit. This is a health-specific plan that allows you to get your complete supply and even sunglasses too. Sound good for you?”

In the event the patient isn’t eligible for CareCredit, simply say:

“Kathy, I checked, and CareCredit isn’t lending right now. Would you like to use a credit card instead, and we’ll break the total cost into three monthly installments so you can take advantage of the savings?”

5 Train team members.

I am convinced that CL compliance is low because of inadequate personnel training. For example, I still hear wellmeaning personnel ask patients, “How many boxes do you want to get?”

Schedule strategic training and role-play practice with office team members to ensure knowledge and consistency regarding the four tips outlined above. Specifically, develop patient scripts, and have staff practice them every week until you are satisfied. Then, revisit this training every three months (quarterly measures get the best response), and retrain when you add new team members.

For instance, front-office staff should be trained to ask CL patients scheduling appointments to present with their current CLs, CL case and any solutions and/or eye drops they are using. This way you, their doctor, can look for signs of non-compliance, such as telltale “rings” in the case, which indicate solution “topping off.”

A work in progress

The tips illustrated above can dramatically increase patient adherence, reducing patient risk of CL-related adverse events and therefore, the likelihood of CL dropout — a win-win situation. “Top of the morning to you” is more pleasant to say than “I see you’re topping off.” OM

Mr. Hinton, CEO and president of eYeFacilitate, was in private practice and is a practice management strategist and communication expert. He travels, lectures and works with private practices. E-mail him at mark@eyefacilitate.com, or send comments to optometricmanage ment@gmail.com.