Patient Education

The Essential Role of Patient Education in Growing My Practice

Patients who understand new technologies and treatments are more likely to utilize them.

Dr. Karpecki is clinical director of Corneal Services and Ocular Surface Research at the Koffler Vision Group-Kentucky Center for Sight. He is on the advisory board for Pixel Optics.

By Paul Karpecki, OD, FAAO

Premium intraocular lenses (IOLs), wavefront-guided all laser cataract surgery, daily disposable or silicone hydrogel contact lenses: new technologies have made amazing outcomes possible in eye care. However, many of the newest options are elective, and patients won’t elect to spend money on something that they don’t understand. This not only reduces revenue for the practice, but also can leave you with a patient who is less than impressed with your services.

The greater need to educate patients is juxtaposed to increasing demands on our time that leave almost all medical personnel in a time crunch. While it may seem an impossible conundrum, quality over quantity is definitely the rule with practitioner-patient time. Whether the practitioner spends two minutes or 20 minutes explaining something, patients recall only whether they felt that all of their questions were answered and that they left with a clear understanding of pathology and procedures. The only way to reach maximum practice efficiency and have satisfied, impressed patients is an effective patient education system. By using tools other than the practitioner to educate patients, everyone makes the best use of their time.

The Patient Education Plan

Our office uses a three-fold system of patient education that starts in the reception area and uses technology combined with personal attention. While patients are waiting, we show patient education videos that include information about contact lenses, the anatomy of the cornea, and what medical procedures the practitioners have performed recently. Visual media is particularly effective because most individuals remember and understand something they have seen better than something they have heard. Showing videos in the waiting area provides patients with a good basis for future discussion with the practitioner, and it keeps them engaged while waiting.

The second phase of education happens while they are in the lane and involves the use of two different tools. The first is a TelScreen (TSi) EyeRes system, or flat screen, that is attached to the slit lamp. Family members can view the anatomy of the eye along with the practitioner, or the images can be captured as video or still images for the patient to review. This allows physicians to share what they observe and explain why the patient may be a good contact lens patient, or why he may be having trouble with his lenses. We use either the same flat screen or an iPad in the exam lane to show patients the animated education videos specific to their situation. In our office we use the Eyemaginations Luma, which has excellent videos about disease states such as cataracts and glaucoma as well as segments about contact lenses and premium IOLs. I can toggle back and forth between the video and the patient’s own eye to relate it to him. Patients already have an understanding of the anatomy of the eye from the videos shown in the waiting area, and the animated videos about disease state help patients achieve far better comprehension than they ever would with just a verbal explanation.

The third phase of our patient education is an email that we send to every patient that summarizes what we talked about, any follow up necessary, and links to the educational animations that they saw in the exam lane to review. All of our printed materials also include our website, which has links to the patient education videos as well. This allows consistency between the website and what patients experience here in the office, as well as allowing them to easily review information and share it with family members who may be part of the decision-making process.

The Impact of New Technology

There are a number of new technologies that are changing the way that optometrists and ophthalmologists practice. Wavefront analysis of the eye’s surface and wavefront-guided surgeries have provided huge leaps in visual outcomes, and new contact lens materials offer patients better vision than ever.

Another advance has been our understanding of the ocular surface and procedures such as osmolarity testing. Previously, physicians used a Schirmer test to analyze the tear film, but it wasn’t comfortable for many patients. Now we first show our patients a short three-dimensional animation about the tear film and the importance of the ocular surface as well as how the osmolarity test functions. The video also shows the meibomian gland, how tears form, and how the physician will check expression of the glands as well as a summary of the entire dry eye process and its potential impact on visual acuity. Patients now anticipate the tests and are eager to hear their results. Because the osmolarity test provides a classification of the tear film from mild to severe, we can evaluate change over time. If a patient is on an eye drop and does not feel symptomatic relief initially, an osmolarity test can show whether he is on track and often provides encouragement to the patient to continue treatment. Teaching patients about dry eye ahead of time so that they know the implications and importance of managing the disease really speeds up the entire process for the physician.

Our practice has made an effort to offer our patients the best by being very technologically advanced. From imaging systems that diagnose disease earlier to wavefront analyzers that can accurately predict the prescription, there are many exciting possibilities out there to enhance a patient’s visual acuity. However, if your patients don’t understand the technology and what you are offering them, they can’t appreciate it. Surveys show that 83 percent of all adults who use the Internet search for health information online (Pew Internet and American Life Project, Generations Study, 2010). This is consistent with the growing trend toward patients desiring more autonomy. While there are advantages and disadvantages to that, without a doubt patients are taking more of an active role in their treatment and want to feel like a partner with their healthcare provider, and patient education is an extremely important element to them.

The Net Gain from Patient Education

Fortunately, better patient education doesn’t equate to more time with the physician. I previously needed approximately 45 minutes with a single patient to explain the various functions of the ocular surface and to complete the battery of tests involved. I now book all of my dry eye patients on the same day so that I can target the educational videos in the waiting room for this audience. Due to the information they receive from these videos as well as those in the exam lane, I am now seeing two to three more patients per hour. All of the technological advances combined with the excellent educational tools allow the creation of a very efficient clinic in which we see 30 to 40 advanced dry eye patients a day.

In addition to practice efficiency, we see gains in patient adoption of advanced technology. Examples such as scleral lenses and even daily disposable contact lenses are an additional cost that many patients initially reject. However, since we began showing our patients educational videos on these lenses, our conversions have increased dramatically. This difference is also noted in the number of our patients who choose premium IOLs. The national average for premium IOL election is around 14 percent (Market Scope Quarterly Survey of U.S. Cataract Surgeons, Q3-2011). However, more than 40 percent of our cataract patients choose premium IOLs.

Oftentimes the most difficult metric to measure is patient satisfaction. However, our well-developed patient education program has allowed us to improve in that area as well. I previously spent more time personally explaining tests and results with my patients, yet office surveys showed that patients felt they didn’t have enough time with the practitioner. Now I see more patients and spend less time with each one, yet our patient surveys reveal that they now feel they receive sufficient time with the practitioner. The difference is comprehension. Patients who leave the office with a greater understanding of their eyes and the treatments possible will be more likely to adopt new technologies, will be more satisfied, and thus more likely to refer others. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #207.