Dr. Vivian Bucay is a well-known dermatologist who practices in San Antonio, Texas. She has frequently lectured at ODAC meetings over the years and her experiences and expertise are always well-received. In the second part of this 2-part series, Dr. Vivian Bucay will share her insight regarding improving patient compliance and adherence to treatment regimens.
Keep it simple
It is hard enough for us to keep up with the rapid pace of medical advances in disease diagnosis and treatment options, and that takes into account that we have the knowledge and background for the context needed to stay current. Imagine using a 15-minute window to complete a history, physical examination, arrive at a diagnosis or more than one, and then share your findings and explain the treatment and have time for questions. Quite simply, we have set ourselves up for failure when it comes to patient compliance. Even worse is that we are setting up our patients to fail adhering to the very things we recommend to improve their conditions.
I find it very helpful to ask patients how willing they are to follow a certain amount of steps and whether or not they have had problems following prior treatment recommendations for that particular condition. Patients know themselves better than we do, and I find that adapting the recommended regimen to the patient when initiating treatment improves compliance. When a patient returns for follow up, we can evaluate the status of the condition and whether adding a medication or another step will be beneficial. The key is to involve the patient in the complexity of the treatment regimen. In essence, this engages the patient in the decision-making process and empowers her/him to participate in the care.
Put it in writing
I want patients to listen to me when we are discussing a diagnosis and proposed treatment, and if they are worried about remembering everything, that anxiety interferes with my attempt to empower them through education. The end result is a shut down in communication. As a countermeasure, I give each patient a customized treatment regimen and list any additional treatment recommendations (chemical peels, laser treatments, skin care recommendations, etc.).
I am passionate about sun protection and enhancing skin wellness through skin care. Explaining the rationale behind a given skin care category – for example, using topical antioxidants to quench free radicals and how keeping free radicals to a minimum will impact the health and appearance of the skin – motivates a patient to include that step in the daily regimen. This same approach also applies to explaining why and how a prescription medication may benefit a patient. With the escalating cost of medications and shrinking insurance formularies and coverage, we must remain sensitive to what patients can and cannot afford and help them access the treatments we recommend.
Training our staff and holding them accountable for following up on patient communications regarding access to medications is critical to improving patient compliance. We cannot personally answer every phone call, call in every single prescription, or tend to every prior authorization, but we can make sure that we empower our staff with the resources to do so. I have templates for prior authorizations for medications for psoriasis, acne, eczema, and actinic keratoses, as well as a list of specialty pharmacies that can help patients obtain commonly denied medications. My clinical staff will use those specialty pharmacies and provide the patient with the pharmacy contact information, and this measure has greatly reduced the amount of prior authorization requests we receive, which in turn frees up the staff to take care of patients, not paperwork.
Pamphlets regarding a vast array of skin conditions, written pre- and post- care instructions, and brochures of laser treatments or other services offered are very useful and, I will joke with a patient that I have now given him/her some homework in researching these topics and treatment options.
One of the most important things I have learned from my patients is that as much as we want to help them and please them, they not only want to get better, but they also want to please us.