How to Encourage Patient Compliance

In the course of daily practice, optometrists will make recommendations and provide medication and refractive prescriptions countless times. However, once the patient walks out of the clinic, the onus falls on them to actually adhere to the advice they’ve been given. Most practitioners who have been in the workforce for any length of time will know that patient compliance can be a frustrating topic – trying to persuade another person to follow advice for their own benefit.

Challenges with compliance can encompass several aspects of practice. These can include taking medication for chronic diseases such as glaucoma, returning for a review appointment or further testing such as a visual field, or even just wearing their glasses as prescribed (a particular issue in children and teenagers). There are, however, possible strategies to improve patient adherence.

Underlying reasons for patient non-compliance

Patient non-compliance, or non-adherence, can be complex and occur for a variety of reasons. It can be intentional or accidental, or a combination of both.1 Understanding the factors that lead to a patient failing to follow a recommendation or persist with a long-term treatment can help the optometrist to develop strategies to improve compliance. Here are just some of the underlying reasons for patient non-compliance.

1. The patient doesn’t perceive the treatment or test as a necessity.¹

This can be especially pertinent to diseases and disorders where the consequences of non-compliance are not immediately apparent. For example, in studies assessing patient compliance for diabetic retinopathy screening, one barrier to attending for the recommended review is that the patient doesn’t believe the retinal exam is necessary as they are not currently experiencing visual disturbances.²

2. The patient is concerned about the safety of the treatment.¹

All clinicians know that patients can have misconceptions about various drugs and therapies. Though unusual, it is not unknown for patients to refuse even routine tests such as fundoscopy for fear that the light will cause damage to their eye. If a patient experiences a negative side effect from a recommendation, such as unexpected stinging from an eyedrop, they are much less likely to persist with the medication. In some cases, they may bring up this concern with the practitioner and seek an alternative, but in many cases, they don't.

3. There is too much inconvenience associated with the treatment or review recommendation. ²

Some patients may be open to following the optometrist's advice but are hindered by significant inconvenience. This may be the distance or time it takes to get to the clinic for a follow-up test, difficulties in ordering the medication from the pharmacy, or the costs associated with the treatment or testing. Some daily therapies, such as using lubricant eyedrops can be inconvenient enough for the patient to cease using them altogether in favour of simply tolerating the symptoms of dry eye (and then complaining about their dry eyes at the next appointment).

4. The patient forgot the details of the recommendation, has a cognitive impairment, or some other practical difficulty in complying with the recommendation.¹

It’s not uncommon for patients to forget to follow through with a treatment recommendation, especially if their most bothersome symptoms have resolved. The original recommendation may have been warm compresses with lid massage for meibomian gland dysfunction (MGD) daily for the first month, then twice a week thereafter. While the patient may remember to do it for the first 4 weeks, once their dry eye symptoms have improved, there's less impetus to continue with this therapy long-term. Patients with dementia or other cognitive impairment should not be expected to perform regular therapies or return for review appointments without the help of a carer. Optometrists should also be mindful when recommending eyedrops for patients who have challenges with manual dexterity; arthritic fingers can make it very difficult to instil drops.

Strategies to Boost Patient Compliance

Though there is no magical formula to ensure patients adhere to every recommendation that comes out of the consulting room, there are steps the optometrist and other staff can take to help encourage compliance.

1. Take the time to understand why the patient has difficulties complying.

If the patient returns and it becomes apparent they have not followed the advice given at a previous appointment, give some time to understand why. The patient may need further explanation of the therapy or the importance of the test or needs an opportunity to discuss their concerns with the original recommendation before feeling satisfied about its safety and efficacy.

2. Use visual aids.

Seeing an illustration of the visual impairment caused by diabetic retinopathy, such as the one provided by Vision Australia, can do wonders in helping a patient understand the importance of regular retinal screening. Likewise, a diagram of eyelid anatomy assists patients in visualising what happens when pressure is applied to the meibomian glands when treating MGD. Even if the patient is not necessarily a "visual learner", visual aids can be a powerful tool.

3. Build rapport.

A patient is more likely to follow your recommendations if they trust you. This is true for both optometrists and dispensers. If you can build patient confidence in your expertise, whether it’s with recommending a treatment or a spectacle frame, the patient trusts that your advice is in their best interests.

4. Explain the treatment or test, but don’t overwhelm the patient with unnecessary information.

You want the patient to walk away being able to remember the most relevant information for their situation, not “there’s another type of corneal ectasia known as Forme Fruste but you don't have that one." Some patients will be happy to do as they’re told with minimal explanation, but others will want to know why they’ve been advised as such, what to expect from the therapy or test, and what are the consequences of not following this advice.

5. Develop a follow-up system.

If you’ve recommended an important review test, such as a repeat intraocular pressure measurement or a tapering schedule of Prednefrin Forte for uveitis, consider following up with the patient rather than waiting for their next routine recall to ask why they didn’t turn up or whether they were alright with the steroid drops. Write yourself a note to call the patient the following day or two to ask whether they have any concerns with using the medication, how is their eye feeling now, etc. Ideally, the patient should have this booked for review appointments before they leave the clinic. If they promise to call back later, write yourself a note to call them if you have yet to hear back after a reasonable amount of time.

Summary

Patient non-compliance can be endlessly frustrating, but some steps can be taken to reduce the number of patients who fall through the cracks. Though it may take some extra time and effort on the part of the optometrist or other practice staff, taking reasonable steps to encourage adherence should be part of the standard of care.