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Encouraging Patient Compliance
Acceptance of intravitreal therapy is never easily won. Consider this advice.
By Sean McKinney, Contributing Editor |
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Few therapeutic regimens in medicine depend on patient compliance for success as much as intravitreal injections.
Yet patient compliance isn't readily achieved because of the unconventional administration route — which is conceptually and sometimes physically
difficult to tolerate — not to mention the paperwork requirements for payment assistance.
What are the best ways to ensure that your patients stay on track?
Less Pleasant Alternative
"I try to make one major point with regard to injections," says Jeffrey S. Heier, MD, Director, Vitreoretinal Service, Ophthalmic Consultants of Boston.
"While injections are obviously not pleasant, I tell patients that the alternative is even less pleasant. Without such treatments, the natural history
of wet age-related macular degeneration (AMD) is for the majority of patients to become legally blind."
Andrew N. Antoszyk, MD, of the Vitreoretinal Service, Charlotte Eye Ear Nose and Throat Associates in Charlotte, N.C., says his approach depends on which
disease he's treating.
"For AMD, I emphasize the importance of compliance to maintain visual function," he notes. "I make it clear that if they don't make their appointments, they
will be at increased risk of losing vision."
For diabetic retinopathy, Dr. Antoszyk says, "frequent treatments are needed during the first year, when I primarily administer ranibizumab (Lucentis) monthly.
After the first year, treatments can be less frequent."
When a patient has a vein occlusion, Dr. Antoszyk's office schedules appointments based on examination findings. "We have to determine whether the fluid is
accumulating," he says. "The fluid may accumulate every 4, 6 or 8 weeks. Depending on what I find, I treat accordingly."
In all cases, careful communication with the patient is critical.
"Clinical trials have shown us that the best visual outcomes — and the best means of maintaining visual gains or preventing visual loss — are
achieved with regular injections,"1 says Dr. Heier. "We go to great lengths to make sure patients understand this."
Dr. Antoszyk agrees. "We know that, in general, when diseases are diagnosed and treated earlier, outcomes are better," he says. "They need to know that treatment
isn't something they can put off for a year."
Overcoming Adverse Effects
Dr. Heier says patients should know to immediately report adverse effects, such as reddening of the eye, eye pain, changes in vision, sensitivity to light and
systemic reactions. "The physician needs to determine if a serious issue is developing. In addition, difficult events need to be addressed to encourage
compliance," he says.
When patients fail to make an appointment, many practices send letters or call to emphasize the importance of making their appointments. "We tell them to reschedule
their appointment as soon as possible," says Dr. Antoszyk.
Compliance is also more likely if the physician, staff and patient literature communicate the same messages. Highlighting pathology on retinograms and OCT scans
is also helpful. "Education, education and education — that is the key," says Dr. Antoszyk.
"Prior to the availability of these injections, patients lost vision at an alarming rate, and did so consistently," notes Dr. Heier. "With intravitreal injections
of anti-VEGF agents, we can stabilize the large majority of patients and achieve visual recovery in a significant number of them. But we can succeed only if patients
are willing to follow their recommended care schedules."
Reference
1. Abraham P, Yue H, Wilson L. Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER study year 2. Am J Ophthalmol. 2010;150(3):315-324.
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