Patient adherence is one of the most challenging parts of patient care and affects all practices regardless of specialty. Poor adherence can lead to negative or delayed outcomes, frustration, increased patient visits, and increased cost to the patient and healthcare system. While patients are ultimately responsible for adhering to treatment protocols at home, there are steps every member of your practice staff can take to help improve the patient’s chances for success.
Here, I discuss the primary reasons for patient nonadherence and how, specifically, allied staff can play a role in increasing the likelihood of patients adhering to their follow-up visits and prescribed treatment plans for their ocular conditions.
Misunderstanding or Misremembering Information
Between 40% to 60% of patients could not correctly recall what their providers told them within 10 to 80 minutes of being given that information. Further, more than 60% of patients interviewed immediately after speaking with their doctor say they misunderstood their provider’s instructions.1
Allied health staff can help combat this reason for patient nonadherence by summarizing to patients everything the OD has discussed, providing paperwork or online/app resources to reinforce the doctor-provided information, and asking patients to repeat the education.
Specifically, it is helpful to ask the patient 2 main questions: (1). “Do you have any questions about what Dr. _____ said?” and (2). “Can you tell me the steps you need to take at home based on the doctor’s instructions?” These questions allow patients to confirm their understanding of the key takeaways from their exam. Additionally, the OD can designate a staff member to act as a patient advocate who calls patients at higher risk of nonadherence periodically to check in and answer questions or provide encouragement.
Complex Instructions
Often, patients will be given complex instructions during their examination due to multiple diagnoses or multi-level treatments, which can lead to adherence difficulty. For example, prescribing multiple medications at once or ordering a frequent dosing schedule can prove challenging for patients, possibly leading to improper timing of drug administration or missed doses.1
If the optometrist cannot provide an alternative method of management in these situations, the allied health staff can increase the likelihood of patient adherence by creating instruction sheets that illustrate which medication to use and when. Additionally, allied health staff can go over the instruction sheet with patients to ensure their understanding and invite questions to ensure clarity.
Physical Barriers
Many patients who present to our practices are not able to comply due to dexterity and/or vision impairments.2
If the OD cannot offer a different course of action that will accommodate the patient’s limitations, allied health staff can combat this reason for nonadherence by providing methods to thwart these issues or by encouraging the patient to invite a friend or family member to an appointment to learn how to assist the patient. An example of a method that staff could recommend to offset a patient’s dexterity challenges might be to show the patient how to instill a drop in the corner of the eye (closed or open), then tilt the head to allow the drop to enter the eye.
Lack of Symptoms
When patients do not “feel” or experience their diagnosis, they are much less motivated to address it. As an example, this is strongly demonstrated in the low adherence seen in non-symptomatic dry eye patients.1,2-4
Allied health staff can help overcome this reason for nonadherence by re-emphasizing the doctor-provided education regarding the fact that the patient may not have symptoms from their diagnosis.
Cost of Care
The out-of-pocket costs associated with care, particularly for treatments and medications, often play a significant a role in patient nonadherence.1
In such cases, allied health staff can help overcome this issue by providing patients with details outlining patient savings programs and rebates from both pharmacies and manufacturers. A well-trained staff will know which savings options there are based upon what was prescribed or recommended by the OD. Additionally, they can help the patient obtain those savings, thereby lowering adherence problems related to cost. For in-office treatments, staff can review payment plans or other financing options for which the patient may qualify.
Inconvenience
Sometimes, just the disruption of a prescribed treatment regimen in the day-to-day routine is enough to make patients poorly adhere to
instructions.
Allied health staff can help fight this roadblock by stressing the negative potential outcomes if patients do not adhere, as well as recommending other activities that the regimen can be tied to. For example, drops that should be used b.i.d. could be aligned with the patient’s teeth-brushing times.
Side Effects
Many medications and treatments can cause adverse reactions or unwanted side effects that may motivate a patient to discontinue therapy.
Similar to issues related to inconvenience, staff should help patients who struggle with side effects by stressing the potential damage caused by poor adherence, giving tips and tricks for overcoming the side effects, and reporting them to the provider to allow for a change in treatment plan if needed.
For example, in eye care, one of the most common complaints is discomfort at the instillation site. Giving tips to lessen these effects, such as instilling a lubricating agent before using the prescription drop that burns, or putting the drops in the refrigerator, can make the experience much more tolerable. (See “Delegate Areas of Expertise,” below.)
A Big Caveat
None of the above steps will be effective unless allied health staff are educated on these reasons and how they can overcome them. OM
References
1. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-159. doi:10.5001/omj.2011.38
2. Zaharia AC, Dumitrescu OM, Radu M, Rogoz RE. Adherence to Therapy in Glaucoma Treatment-A Review. J Pers Med. 2022;12(4):514. Published 2022 Mar 22. doi:10.3390/jpm12040514.
3. Uchino M, Yokoi N, Shimazaki J, Hori Y, Tsubota K, On Behalf Of The Japan Dry Eye Society. Adherence to Eye Drops Usage in Dry Eye Patients and Reasons for Non-Compliance: A Web-Based Survey. J Clin Med. 2022;11(2):367. Published 2022 Jan 12. doi:10.3390/jcm11020367.
4. Keenum Z, McGwin G Jr, Witherspoon CD, Haller JA, Clark ME, Owsley C. Patients’ Adherence to Recommended Follow-up Eye Care After Diabetic Retinopathy Screening in a Publicly Funded County Clinic and Factors Associated With Follow-up Eye Care Use. JAMA Ophthalmol. 2016;134(11):1221-1228. doi:10.1001/jamaophthalmol.2016.3081.
