Despite receiving prescriptions for medications that can arrest the insidious, sight-stealing disease that is glaucoma, patient non-adherence rates to these drugs range from 16% to 67.5%, according to a recent study in Cureus. In noting this in the glaucoma clinic at Eye Care Associates Inc. (ECA), an almost 90-year-old, multi-specialty practice in Ohio, allied health staff are having one-on-one conversations with patients, on the heels of the glaucoma specialist’s initial discussion, to break down the most common barriers to compliance they encounter.

“Patients consider the allied health staff an extension of me, their doctor, so the one-on-one conversations the staff have with patients are paramount to getting patients to adhere to their prescribed treatments,” explains John P. Aey, MD, the practice’s glaucoma specialist. “I simply couldn’t effectively manage my patients without them. It’s a symbiotic relationship.”

He adds that the discussion of surgical intervention, which includes selective laser trabeculoplasty, trabeculectomy, goniotomy, OMNI (Sight Sciences), canaloplasty, Hydrus microstent (Alcon), XEN Gel Stent (Allergan) and tube shunts, is his alone, as surgery is in his wheelhouse. That said, he acknowledges the staff does tell patients they may still have to use eyedrops after the surgery. In terms of when surgery becomes an option, that is “truly individualized to each patient,” he says.

Here’s a look at the conversations allied health staff of ECA have with patients to overcome barriers to medication compliance, starting with the two most commonly cited.

Cost of medication to patient

One-on-one conversation. “I’m going to make a note of this to the doctor, so he can see whether it’s possible to switch you to a generic version of your medication, which should cost less. If this isn’t possible, other options include switching to a less-expensive pharmacy, looking online to see whether the pharmaceutical company offers a coupon for the drug, or I can put you in touch with our patient advocate staff member, who can try to help. One of these options should get the drug you need, which is essential for retaining the vision you have.” – Alana Harvey, ophthalmic tech

Ms. Harvey adds that she sometimes recommends a local pharmacy that offers lower prices than major retail pharmacies, and that the patient advocate gives patients coupons. (See “Patient Advocate Role,” below.)

Forgetfulness

One-on-one conversation. “In addition to the medication instruction sheet provided at your last visit, I would suggest setting an alarm to take the medication(s), using a calendar you often refer to, and/or trying to make it part of an already established routine. As an example, using the medication(s) at specific mealtimes.” – Rachel Kowalski, COA, chair assistant to the practice’s glaucoma specialist

She adds that she usually draws something for each patient that states the name of medication, cap color, and instillation directions, such as one drop into eye(s) right, left or both, twice daily (breakfast time, then again at dinner time), at the initial prescribing visit.

Misunderstanding
of disease

One-on-one conversation. “Glaucoma is a progressive disease of your optic nerve. Think of your optic nerve as the power cord for your vision. In glaucoma, the optic nerve is no longer able to provide you with a full charge, and the remaining charge is slowly deteriorating. In fact, the deterioration process can be so slow that many patients don’t even realize something is wrong until they start noticing changes in their peripheral vision. This is why the condition has been named the ‘silent thief of sight.’

"While there’s currently no cure, the disease can be managed with
medication, so you can retain your current vision.” – Ms. Kowalski

Medication purpose 
confusion

One-on-one conversation. “The drops the doctor prescribed are not designed to improve your current vision; they are designed to preserve your current vision. When you don’t use your medication or take it as prescribed, you will eventually notice irreversible vision loss.” – Alex Thomas, ophthalmic tech

Side effects

One-on-one conversation. “The side effects of anti-glaucoma drops are often burning and redness. You can decrease, not cease, these side effects by using artificial tears, though not for 30 minutes before or after intraocular pressure (IOP) medication instillation. I realize feeling burning or experiencing redness is not pleasant, but preserving the vision you have depends on you taking the medication, and as prescribed.” – Ms. Kowalski

Inconvenience

One-on-one conversation. “I get it. There are things I have to do that I also find inconvenient, like paying bills. But if I don’t pay my bills, I won’t have heat, water, or a place to live. If you don’t take this medication and as prescribed, you will permanently lose vision.” – Ms. Harvey

Eyedrop instillation
One-on-one conversation. “Instead of tilting your head and looking up, stand in front of a magnified mirror, gently pull on your lower lid, and instill the drop. This way, your eye won’t automatically close, preventing the drop from entering your eye.”
– Ms. Harvey

Successes

While the allied health staff in the glaucoma clinic at ECA does not have analytics on their verbal efforts to break the barriers to glaucoma medication adherence, proof of their success is demonstrated in vignettes such as this one:

“This patient in his 70s told me a while back that he wasn’t using his medication because he didn’t see any beneficial change in his vision,” recalls Ms. Harvey. “Ever since I explained to him the purpose of the medication and that I didn’t want him to be seeing life through a straw, he finds me at each follow-up visit to say, ‘I’m using my drops!’ I think having these one-on-one conversations makes a difference because patients know we really care, and they become accountable for their actions.” OP

PATIENT ADVOCATE ROLE

In noting that roughly 80% of the practice’s glaucoma patients are on Medicare, and that several are on fixed incomes, Eye Care Associates Inc. created the patient advocate role, held by Amber Frommelt, COA, so patients can get the glaucoma medications they need.

“Knowing that I’m playing a role, along with my fellow allied health staff members, in doing everything in our power to save these patients’ vision is hugely gratifying,” says Mrs. Frommelt, who held the role of ophthalmic tech for 17 years prior to the creation of the patient advocate role 2 years ago. 

As patient advocate, Mrs. Frommelt says she completes all prior-authorization requests, investigates tier exceptions, files appeals, participates in peer-to-peer discussions with insurance companies, and fills out most of the applications for pharmaceutical company patient assistance programs.

“Patient advocacy requires a lot of patience and time to communicate with both the insurance companies and patients,” she acknowledges. 

She offers this pro tip: Go to CoverMyMeds.com to fill out prior authorizations online. This way you won’t have to wait on hold with individual insurance companies for 40 to 45 minutes. OP