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Optimizing compliance in patching therapy


Introduction

Conventional occlusion therapy (patching the preferred eye) remains the first line of treatment for amblyopia. One of the main predictors of success is patient compliance with occlusion therapy, that is, the ability of parents and children to carry out this treatment at home. Many factors may contribute to the family’s ability to carry out occlusion treatment. These include appropriate education, consideration of psychosocial factors, level of vision, motivation, and the cost–benefit balance. Identifying and overcoming these barriers to compliance early on in the management of amblyopia will help to achieve greater success.

Barriers related to the patient and family understanding of amblyopia and its therapy

Insufficient patient and family education

If the family does not understand the diagnosis of amblyopia and how patching will help their child’s vision, then compliance will be impacted. Explaining the diagnosis, rationale, and goals of treatment will improve cooperation with treatment and attendance at follow-up visits. The child needs to understand and accept he patch, which can be quite distressing at first.

Cultural beliefs

When caring for a socially, ethnically, or religiously diverse patient population it is important to recognize that a treatment may not be equally acceptable or even possible across all groups. Consider the family structure and roles of the caregiver, and even social concerns about the appearance associated with wearing a patch or glasses.

Language barriers

If the patient/parent and the clinician do not speak the same language, an interpreter should be asked to attend the explanation session.

Multiple caregivers

When advising a family, identify the individuals who will be supervising the child. This may include multiple family members, daycare workers or teachers, among others.

Tips

  • Take the time to discuss the diagnosis and treatment plan, including treatment goals and expectations, during the initial visit and encourage the family to ask questions to make sure they understand. Provide ongoing support at each follow-up visit to help troubleshoot difficulties.

  • Involve the patient and family in the treatment planning process. In this way, the family’s concerns or misunderstandings can be openly addressed so that a management plan can be developed that will best fit with the family’s values.

  • Provide information, both verbally and in writing, using simple language and terminology that can be easily understood by everyone. Cartoons or stories may help young children to better understand the treatment and provide a tool for parents to encourage the child’s cooperation.

  • Give written information to use as a reference at home when the treatment is first prescribed. When possible, this information should be provided in the family’s first language. This will enable information to be shared with all caregivers in the patient’s care circle so that they are able to participate in the treatment effectively.

  • When language barriers exist, consider having a translator available at the appointment or via phone to assist with patient and family education. When a professional translation service is unavailable family members, including the patient’s older siblings, will often act as effective translators.

Barriers associated with inconsistent instructions and follow-up

Frequent changes to the treatment plan

Inconsistency in information provided and the instructions given at subsequent visits can lead to confusion and questions about the validity of treatment. This can occur when there is more than one clinician involved in following up with the treatment plan.

Inconsistent follow-up schedules

Irregular intervals between visits may lead to missed appointments or rescheduling of the appointment with an inappropriate delay in follow-up time.

Tips

  • As much as possible the patient should be seen by the same clinician at each follow-up visit. This ensures information and approach to treatment is consistent and also helps to build a relationship of trust between the patient and clinician.

  • Follow-up intervals should be regular and consistent. The family can be informed at the outset of treatment that a number of visits will be required with standard timing. This gives the family opportunity to plan for attending visits. Regularity also allows for the family and staff to ensure follow-up schedules are maintained in the event of appointment rescheduling.

  • Use clear and consistent communication methods to chart information in the patient record so that all team members can track the treatment and instruction provided to families in the event that they are seen by another clinician.

  • An established clinic protocol for amblyopia management including occlusion times, intervals between visits, and indications for adjusting treatment based on outcomes can be a help to ensure consistency.

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