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6 steps to establish an OSD advocate in your practice


two doctors communicating at a table

Her name is Diane Becerra, and I could not care for my dry eye patients like I want to without her.

The business of ocular surface disease can be overwhelming to some ODs. There are many challenges to overcome, including but not limited to establishing diagnostic and therapeutic protocols, patient education, compliance, and flow.

When I recognized the impact of ocular surface disease on my patients’ quality of life and implemented an ocular surface disease (OSD) practice algorithm, medical follow-up visits tripled in six months. I could not have done this successfully without the full support of my staff.

Related: How to create an ocular surface disease treatment protocol

While the doctor must set the tone and keep the big picture in mind, it is the engaged staff who will make it happen in practice. Symptomatic dry eye patients can be some of the most challenging and demanding. Because doctor time is valuable, it is common sense to delegate as much to staff as much as possible. While all team members should be able to educate patients and fulfill the doctor’s recommendations, it is helpful to have a team leader. Identify a staff member who has exceptional people skills. Some desirable traits are empathy, confidence, and learning and listening skills.

Essential responsibilities of an OSD advocateUnderstand the disease state
Allergic conjunctivitis, blepharitis, meibomian gland dysfunction, and dry eye disease are prevalent conditions that ODs see daily in practice. Have staff shadow you to learn more about these common ocular diseases, associated patient symptoms, and your therapeutic approach. A digital biomicroscope is especially helpful. Utilize online resources to educate.

Related: Your glaucoma patients also have ocular surface disease

Industry will often provide "lunch and learn" opportunities for staff education. In my visits to many successful dry eye clinics around the country, I have found that some of the most successful team leaders are also dry eye sufferers.

Learn diagnostics
Before the patient gets to the doctor, the staff performs screening and appropriate diagnostics. A patient questionnaire is handed out at reception with symptomatic patients tested for inflammation and hyperosmolarity. Several devices can image tear film break-up time (TFBUT), tear meniscus, conjunctival redness, lipid layer thickness, and meibomian glands. Most companies providing these tests will gladly train staff. With so many diagnostic parameters, staff efficiency is vital.

Related: New guidelines in OSD evaluation before surgery

Educate patients and encourage compliance
The doctor should briefly educate patients about their diagnoses and prescribe a treatment plan that notes the importance of adhering to directions. Staff is then responsible for driving compliance. Printed materials with checkboxes allow for productive, efficient discussions. Patients also have something to take home to gain a better understanding of the doctor's findings and prescriptions.

Staff should work on becoming fluent in their presentations to patients. One training technique includes presenting to other staff. A video recording can be very useful for feedback.

Compliance is a critical part of the process of ensuring good patient outcomes, and it can be the toughest part, as well. Staff must reinforce the "why" behind the treatment plan. Listening skills and empathy are essential in this step because dry eye patients often want to be acknowledged and heard.

Staff must also learn to address objections to time or cost. Ensure that follow-ups and procedures are scheduled, and prescribed products dispensed immediately following the examination.

More by Dr. Schachter: Utilize online community for OSD management

Learn in-office treatments
Innovation has led to more in-office treatment options than ever. Lid hygiene kits and devices, meibomian gland expression, and intense-pulsed light have made their way to optometric practices, and team personnel is able to perform these on their own or at least assist with patient prep, clean-up, and education after the procedure.

Practicing on other team members will not only increase staff skill level and comfort in performing the procedures, but it will also show other staff the benefits of these techniques.

Related: Do ODs take chronic inflammation seriously?

Keep diagnostics and therapeutics stocked
Replace consumables, as needed. Many of the in-office devices have disposables. We sell take-home products such as artificial tears, commercial heating masks, lid hygiene products, and nutraceuticals at my practice. To maintain a smooth flow, make sure all products are readily available.

Track metrics
It is no small investment to have a fully equipped dry eye clinic. Establish benchmarks to ensure your practice is meeting goals. If it is not, conduct team discussions to uncover reasons for falling short. Your team leader can make sure a system is in place and consistently followed.

More by Dr. Schachter: Video: Why competition drives innovation in the optometric marketplace

Take a look at comments from these successful OSD doctors about the importance of an “OSD advocate.”

Among imaging, point-of-care testing, education, prior authorizations, and treatment plans, my ocular surface disease team is absolutely essential to our success. These are amazing patients to treat. It takes all hands on deck to lean into this multifactorial disease. Don't live in a vacuum and try this alone, empower your team.
-Selina McGee, OD, FAAO
Edmond, OK

Our ophthalmic hygienist is an indispensable part of delivering education and performing delegated in-office procedures. It not only enhances and differentiates the patient experience, but it is an economic tool to diversify my chair time.
-Richard Maharaj, OD, FAAO
Brampton, ON, Canada

My dry eye counselor is a vital component to the overall care with my patients. She helps in testing, scheduling, and educating my patients, which frees up my time, allowing me to see more dry eye patients in a day. I couldn't get through my day without her.
-Kimberly Riordan, OD
San Marco, FL

Related: Corneo-scleral topography allows for precise fitting

Our incredible OSD advocate makes every dry eye patient feel cared for and enhances our efficiency, effectiveness, and experience.
-Laura Periman, MD

My patient coordinator goes over all the financials, logistics, and final details and reassures the patient of the upcoming OSD procedures. Each staffer has gone through the process themselves and can give their honest feedback for patients who have doubts. Empower your staff, and they will do what's best for the patients.
- Vin Dang, OD, FAAO
Bakersfield, CA

Dry eye disease management requires a team approach for the greatest opportunity for success. Technician Ramon Gómez begins the education process by helping patients understand the basics of dry eye disease and the diagnostic test he performs. Additionally, he builds rapport with a group of patients who are often frustrated and looking for answers. Having a technician who is invested in dry eye disease sets the doctor, patient, and practice up for success.
- Whitney Hauser, OD, FAAO

Find an “OSD advocate” in your practice. Your patients and practice will be grateful.

More by Dr. Schachter: OD text groups keep the conversation going

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