New M.D.

Empower Patients to Take Their Meds

By Allen Hu, M.D.

One of the most frustrating problems for new ophthalmologists entering clinical practice is encountering patients who do not follow treatment recommendations. We became ophthalmologists because we recognize the devastating impact that loss of sight can have on one's quality of life. It is difficult for us to fathom why patients do not adhere to our proposed treatments.

Patient adherence strengthens the physician-patient relationship by minimizing poor outcomes that can result in unhappy patients. Thus, it is extremely important that we, as new ophthalmologists entering practice, know how to build a therapeutic alliance with our patients.

Identifying Non-Compliers

The first step to better adherence is to identify the noncompliant patient. I now avoid asking closed-end questions like: "Do you use your eyedrops?" Instead, I ask open-ended questions like: "How do you use your drops?" It is not uncommon that patients will reply, "Doctor, isn't it all written in your chart?" Many patients feel uncomfortable admitting failure in performing such a simple task. Usually, they know when they should be using the drops, but something in their daily lives prevents them from complying with our instructions.

So what are these obstacles? In my encounters with patients, the most common barriers are patient misperceptions in such areas as treatment goals, convenience, cost, cultural beliefs and the need to adjust habits. The physician might discover that the patient did not understand the purpose of an antibiotic drop, i.e., to prevent infection. It may be because the patient is having difficulty administering the medication. They may have a physical disability such as arthritis, preventing them from opening cap on the bottle, or a chronic illness like Alzheimer's dementia, affecting their ability to remember when they should take their drops. Or they may be on so many different eye drops that it is difficult for them to keep track of everything. Some patients may find that the eye drop irritates the eye. Perhaps the patient is unable to afford the medication. Even if patients begin the prescribed treatment, they may discontinue it if an immediate perceived benefit is not realized because they do not understand the treatment goals.

Tips to Improve Adherence

In other cases, proper preoperative planning can improve patient adherence. If a postop patient needs to maintain a specific head positioning after eye surgery, it is important to anticipate potential barriers to noncompliance and make appropriate preparations before the procedure, such as enlisting support to assist with activities of daily living. This will improve patient adherence to postoperative instructions.

So what can we do to improve patient adherence? First, patient education cannot be overemphasized. Treatment goals should be clearly explained to patients in terms that they can reasonably understand. Explain potential side effects of medications like redness, stinging or blurry vision so that patients know what to expect and will not self-discontinue the medication. Second, it is important for the patient to have support at home and to educate and enlist the help of family members, especially for patients with physical or mental disabilities. Third, most patients have a difficult time recalling verbal instructions, so using preprinted forms listing common ophthalmic medications and frequencies can improve patient adherence. You can also make suggestions on how to incorporate eyedrop administration into daily routines (like putting their eyedrops next to their toothbrush as an easy morning and bedtime reminder). For patients who cannot afford the medications, try to provide free samples or prescribe a less expensive but equally efficacious medication. Lastly, clearly document that you emphasized the importance of following treatment recommendations to protect yourself from a litigious patient who has complications resulting from his or her own noncompliance.

By understanding the patient's circumstances, I hope these suggestions will help you to improve patient adherence. Ultimately, this will lead to stronger therapeutic alliances between you and your happier patients. OM