Eyeworld

September 2018 • Ophthalmology Business 17 update your instruction process. When patients read and listen to the instructions given, as the vast majority of patients do, Dr. Ozerov finds they are compliant. "Issues arise when a patient does not pay atten- tion to the information provided and gets confused about dosing, frequen- cy, and how long they need to stay on the drops," she said. One patient group that may need additional support for drop use is older patients who live alone and do not have help, Dr. Scott said. This can be a challenging group in terms of following their instructions and their drop regimen. 9. Encourage patients to bring their drops to the office. "No one remem- bers what drops they're using or what the names of those drops are," Dr. Parker said. "That's why it's critical to have the patient bring all eye drops with them to every visit, so that we can verify that they're using the correct one in the correct amount." This alone has helped practice staff address compliance issues more than all other efforts combined. 10. Occasionally update your instructions to reflect changes in your practice or surgical approach. For example, Dr. Al-Aswad no longer stops anticoagulants for cataract surgery and most glaucoma proce- dures. She also has patients resume daily activities earlier than previous- ly, including showering. She will give instructions for patients with special health conditions (such as diabetes or glaucoma) based on disease severity and surgical procedure versus a blan- ket plan for everyone. OB Editors' note: The physicians have no financial interests related to their comments. Contact information Al-Aswad: Laa2003@cumc.columbia.edu Casey: 702-633-2020 Ozerov: iozerov@gmail.com Parker: jack.parker@gmail.com Patterson: 931-456-2728 Scott: 410-571-8733 use each day and add a check-off area each time that drop is used. Additionally, patients can bring the chart with them to postop appoint- ments so you can check compliance. "This extra measure ensures compli- ance and best patient results," Dr. Casey said. 6. Anticipate common questions and address them accordingly. For example, because patients often will ask what time of day to use the drops, Lama Al-Aswad, MD, MPH, associate professor of ophthalmol- ogy, Columbia University Medical Center, New York, will connect the drops instructions to specific daily activities, such as breakfast, lunch, dinner, and before going to bed. 7. Consider eliminating drops. Because drop use is often the most confusing topic for cataract surgery instructions, a number of surgeons now use intraoperative injections instead. Dr. Casey uses a transzonu- lar injection of antibiotic and steroid medications at the end of surgery, so postop medication compliance is a non-issue for him. He explains this to patients by framing it as an evo- lution of cataract surgery that now includes advanced technology IOLs, femtosecond laser-assisted surgery, and intraoperative aberrometry. "Others in my practice use a 'less drops' approach where combination antibiotic/steroid drops are formulat- ed at a compounding pharmacy. This is more convenient and often more cost effective than name-brand eye drops," Dr. Casey said. Dr. Patterson also recently switched to injections versus drops and has found it extremely helpful. "Simplifying the drops as much as possible is paramount," said Maria Scott, MD, medical director, Chesapeake Eye Care and Laser Cen- ter, and LASIK surgeon, TLC Laser Eye Centers, Annapolis, Maryland. "Ideally, the drops will eventually be eliminated as we move to a lacrimal depot of drops or longer activity intracameral injections." 8. Monitor compliance so you can analyze where you might need to information." Having your instruc- tions in writing and repeated verbally can help reach different learning styles. The staff at Dr. Patterson's practice will also print out fresh custom-made instructions for each patient versus using copies of copies. The latter start to fade, making them harder to read, he said. 2. Build in verbal reviews at specif- ic time points. "We find that verbal reviews at different times by different professionals as well as the printed instructions are extremely effective," Dr. Ozerov said. Specifically, instruc- tions are covered when patients meet with Dr. Ozerov, when they are with the surgical scheduler, and with a technician when patients return for their postop visit. Reviewing postop instructions with a family member is also helpful, Dr. Patterson said. 3. Consider adding informational videos about cataract surgery to your website. Many surgeons said they do not provide cataract surgery instructions on their website because instructions must be tailored for each patient. However, your website could have supplemental information, such as educational videos on what to ex- pect with surgery and general infor- mation about eye drop use, said Paul Casey, MD, NVISION, Las Vegas. 4. Encourage patients to call your office with questions they have. This may seem obvious, but Dr. Casey has found that too many information sources, including the internet and well-meaning family members and friends, can confuse patients. He has even seen patients receive conflicting information from per-diem postop nurses at ASCs who work with a variety of specialists. Their instructions may reflect general recommendations given by other physicians and not what cataract sur- geons want, he said. To help patients avoid confusion, make it clear that patients should turn to your office for any questions. 5. Provide a check-off chart. Some practices make a chart that shows which specific drops patients should

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