What about noncompliance?

October 31, 2013

I used to take noncompliance personally. I was failing my patients as their eye doctor. After all, it’s my job to explain the risks of contact lens wear and care non-compliance, and if my patients weren’t complying then I must be doing a poor job of communicating those risks. One of the many points I learned: It’s not my fault!

I get to write a lot with this gig. While I take pride (and responsibility) for everything I’ve ever written, October’s issue contained an article I’m especially proud of for several reasons. “The High Cost of Non-Compliance,”http://optometrytimes.modernmedicine.com/optometrytimes/news/cost-contact-lens-and-lens-care-noncompliance, discussed patient non-compliance with contact lens wear.

I am especially pleased with the paper firstly because it is the initial collaborative effort between myself and our editor-in-chief, Gretchyn Bailey. I really hope to do more of these collaborative pieces with both Gretchyn and our Associate Optometric Editor Kathy Mastrota. Two sharper people I have never met. I am satisfied with the piece because it also helped me to understand patient non-compliance in a larger perspective.

How many of you are more than mildly vexed with your patient’s non-compliance with contact lens wear and care schedules? For years I’ve watched in silent and sometimes not-so-silent frustration as my patients abused their eyes with contact lenses. It is little wonder contact lens patients are often called the junkies of eye care. It seemed that no matter of persuasion could alter the habits of these patients. Don’t get me wrong-the great majority of our contact lens-wearing patients are compliant with our recommended wear and care recommendations. Yet that minority are the ones who would cause me to pull out my hair (if I had any).

I used to take noncompliance personally. I was failing my patients as their eye doctor. After all, it’s my job to explain the risks of contact lens wear and care non-compliance, and if my patients weren’t complying then I must be doing a poor job of communicating those risks.

One of the many points I learned preparing this piece: It’s not my fault! Many of these patients aren’t going to comply no matter what you say. Some of them even think they are complying with your instructions, but in reality they aren’t.

The other point I learned is we as eyecare providers aren’t alone in our noncompliance conundrum. Patient noncompliance with systemic medications is a huge medical problem, causing over a 100,000 deaths each year, up to 25% of all nursing home admissions, and costing our healthcare system over $317 BILLION dollars annually.1

The question still remains: How do we get our patients to comply? We make the point that patient education is the key and hit compliance hard with every contact lens patient at each and every visit. Changing to a daily disposable lens seems to help. I keep really gruesome pictures of corneal ulcers and other contact lens complications posted on my exam room walls so I can reference them for all my noncompliant patients. I give patients wear and care handouts.

I probably sound like an optometric version of Chicken Little: “You’re going to get an ulcer! You’re going to get an ulcer!” That concerns me because the great majority of noncompliers aren’t going to have an adverse event, I’m sounding like a harbinger of doom when doom isn’t coming, and I worry that my patients are going to tune me out.

Lately I’ve been thinking that perhaps the best way to get through to the hard-core contact lens abusers is to hit ‘em where they’ll understand-in their wallets. One study mentioned in the article discussed treatment costs of adverse events and found them to be pretty high.

I prefer to point out to the patient in my chair presenting with the “positive washcloth test” that this corneal ulcer is going to cost you $X in an office visit, $Y in topical medications, and you may or may not lose $Z in missed wages while you’re treating the eye. All of which could’ve probably been prevented had you worn your contact lenses as recommended and cared for them as you should.

Harsh? Probably. Those patients seem to get it, though. My most compliant patients are those who have had an adverse event. They simply don’t want to go through it again. Or maybe they’re just going somewhere else where there is no hassle for their lenses-like the corner convenience store. Alas, that is another discussion…ODT

Reference

1. Express Scripts 2011 Drug Trend Report. Available at: http://www.drugtrendreport.com/docs/DTR-2011.pdf. Accessed 9/11/13.