Comanaging with confidence

The end game of any comanagement arrangement is providing patients with the best possible care they can receive. This seemingly obvious conclusion is sometimes clouded by the perception that optometry and ophthalmology are not working in tandem, and patients may be left confused and unsure about what is the best option for their ophthalmic care.

A true partnership can and should be established with high-quality surgical ophthalmologists who share in your vision and can provide your patients with the modern state-of-the-art technology. This necessity for a true comanagement relationship is no more apparent than at this very moment, with optometrists serving as primary-care providers and ophthalmologists providing surgical care for the aging population.

Patient education

The process of diagnosing and treating medical conditions is an ongoing course and should be instilled in your staff from the beginning. When patients call the office to inquire about an appointment, they should be greeted with questions regarding the nature of the visit. Often patients are unaware that optometry is pivotal in treating first-line ophthalmic diseases.

How does this relate to the comanagement of your patients when it comes to surgery? As in every learned method, it starts at the beginning-at the first impression, your patients should know you are more than just an office that provides contact lens and glasses prescriptions. Rather, we are a medical office with a focus on the health of your eyes and also can provide you with a contact lens and glasses prescription. Knowing that you have your fingers on the pulse of new medical technology provides your patients with an educational resource of ophthalmic treatments.

Thus the key is the education that your practice can have available to help your patients with decisions, such as the surgical options a medical diagnosis will encounter. Who better to guide patients than the doctor who has been caring for their vision for years? As optometrists, we wield a lot of influence over patients, and their trust in our decisions creates a long-lasting relationship that should be nurtured. We are fortunate to be in a time when there is an abundance of surgical choices for our patients to ponder. No longer is eye care predicated on just treating the patient to read the Snellen chart; rather, it is based on the personal visual demands of the individual.

For example, look at the doctor-patient relationship with laser vision correction (LVC). Modern-day LVC is synonymous with an efficacious and safe procedure for patients who fit the criteria. There is very little doubt that if a patient is a good candidate, he can expect a great result. This has been accomplished by the advancements in wavefront technology, laser-assisted flap formations, pre-operative evaluations, and patient satisfaction. These same advancements are seen in the care of the cataract patient. Arguably, the cataract surgery is a modern-day refractive surgical procedure, and who knows more about their patients than primary-care providers?

The same educational process of any procedure in your practice should be extended to the surgical cataract patient. Simply stated, you need to have a plan to educate the patient early about the cataract, the surgery, time of post-operative medications, the specifics of the procedure, and the options available to that patient. Moreover, you have to feel the same amount of confidence in this process as you would fitting your patient with a contact lens. You know the lens brand, you know the limitations, you set the follow-up schedule and fees, and you relay all that to the patient at the visit. The only difference in the cataract scenario is that you are working with another specialist to provide some of the care and most likely share in some decisions. Yet, as stated earlier the ultimate goal is to provide your patient with high-quality vision and an experience that does not leave doubts about her decisions.

There is no greater time than now, today, to set up a site visit with the local surgeon in your town who you think has superior surgical outcomes. There are questions that you need to answer for yourself and those can be satisfied only if you make the effort to call on his or her office. In fact, calling the office as a potential patient to hear how staff handles the incoming patient call will help to elucidate what your patient will experience. This will also give you an insight into the customer service that is provided by the comanaging center.

Comanagement as a partnership

The comanaged relationship should be viewed as a partnership in the care of the mutual patient, and having the same language and information coming from both facilities will only solidify this relationship. As someone who works on the surgical side, I know all too well who has invested in the time to educate the patient on the cataract process vs. those who wait for the process to take place in the surgery center. More often than not, the patient will want to stay in the facility that has been the most interactive and educational, and has demystified the surgical procedure.

When you set up that initial or ongoing meeting with your local surgeon, inquire whom the patient will be seeing when she comes to the clinic. The surgical coordinator will be the best resource for what your patients will hear from that facility; however, do your homework. The surgeon’s Web site will provide details about what specific lenses and surgical platforms. Patient testimonials may also be featured.

When speaking with the coordinator/surgeon, get a detailed pre-operative regiment for the clinic. Recent studies have shown that many patients suffer from undiagnosed dry eye prior to cataract surgery,^1-3 and because we know that this can alter the measurements, you should be prepared to treat the ocular surface. Some surgeons require patients take medications, use lid wipes, or alter drop regiments; knowing this prior to sending the patient for a surgical evaluation enables seamless comanagement. Furthermore, it is important find out what criteria is used to decide what specific lens is offered for each patient. For example, in my practice, we think any patient with at least 0.75 D of astigmatism may benefit from a toric lens.

A great comanagement arrangement is much like parenting. When the message is the same from both doctors, patients have fewer doubts. When you sit down with the surgeon, it is paramount that you express your philosophies and, although they may not be perfectly in sync with the surgeon’s, they should be in line. Discuss what role you want your practice to take in the educational process and the comfort level you feel with all the different technology.

There should be a plan about how to handle unexpected surgical sequelae. What form of communication is going to get the best results and provide an immediate resolution to the problem without creating undue stress for the patient? The bottom line is the open lines of communication and a mutual respect of each other’s role in the surgical process.

Your office can provide marketing materials that explain the procedure, when and if a laser will be used, different lenses available, and a biography of the surgeon. To further solidify comanagement with this surgeon, call the surgery center to set up your patient’s preoperative evaluation. Using an appointment card with your name as well as the surgeon’s is another opportunity to present a cooperative approach. In fact, if you know when the surgery is going to take place, establish the follow-up appointment in your practice commensurate with the schedule you have established with the surgical center. Making a personal connection with your patient as he goes through the surgery, such as a call or card sent on the surgery day, can demonstrate your high level of care for this patient.

Mutual respect and cooperation is the key to a great comanagement arrangement. The optometrist’s longstanding relationship with the patient and the confidence in the surgeon is a winning combination for all involved. Establishing your office as a comanagement center ensures that you are committed to your patients’ quality of life and an active participant in the surgical process.ODT

References

1. Luchs J, Buznego C, Trattler W. Prevalence of blepharitis in patients scheduled for routine cataract surgery. Poster presented at: ASCRS Symposium on Cataract, IOL and Refractive Surgery; April 11, 2010;Boston,MA.

2. Trattler W, Goldberg D, Reilly C. Incidence of concomitant cataract and dry eye: prospective health assessment of cataract patients. Presented at: World Cornea Congress; April 8,2010;Boston,MA.

3. Movahedan A, Djalilian AR. Cataract surgery in the face of ocular surface disease. Curr Opin Ophthalmol. 2012 Jan;23(1):68-72.