Practice Management

Patient Contact With the Practice

The initial engagement of today’s patient with an eye care practice likely takes form online. A new patient may have undertaken an Internet search based on locality or desired clinical services, and/or received a recommendation from a current patient. A returning patient is likely to use Internet search to locate a phone number or online booking capacity. The returning patient may be contacting the practice of their own volition – to book an eye examination or order contact lenses – or may have received an examination recall. The mode of contact should provide sufficient information for the prospective or returning patient to confirm their course of action – for example information on contact lens options and fitting and how to contact the practice.

Regardless of the mode of contact for a new or returning patient, the first opportunity for discussion is typically a phone conversation. Practice staff must be provided guidance and a system for ensuring correct utilization of the ECP’s appointment book, which is the ‘engine’ driving the eye care practice. Practice staff can be trained to ask specific questions about the patient’s intention for their appointment – for example is it for spectacles, or contact lenses, or an eye health concern – to ensure pertinent information is passed onto the ECP prior, or at the time of the appointment. Practice staff are also best prepared for questions frequently asked by patients, to ensure informative conversations and conversion into appointment bookings. The ECP can be instrumental in providing informal education or ‘sound bites’ on clinical questions posed by patients to practice staff, as a process of training or as the need arises. Typical questions patients may ask specific to contact lens practice, for which practice staff should be prepared, include:

• Can I get contact lenses at my appointment?

• How much are contact lenses?

• I’ve been told I can’t wear contact lenses before – is that true?

• Am I suitable for contact lenses?

• How long does it take to get contact lenses?

Providing clear, succinct communication on these typical patient questions is important to form and maintain the relationship between the patient and the practice, setting the tone and expectations for the patient’s in-person interaction with the practice team at the time of attendance. Table 40.1 provides an outline of considerations in preparing communication for practice staff to answer these frequently asked questions, along with brief options from which to build practice-specific answers.

If taking an appointment booking via telephone, the practice staff member booking the appointment should gather information enough to contact the patient to confirm their appointment. Gathering the patient’s full name and a contact phone number is typically sufficient, to allow for a confirmation of the appointment a day or two before the date of the booking. For a previous patient returning to the practice, this would involve confirmation of this information to ensure contact can be made. A confirmation of the appointment can be made either via phone call, or a single or bulk mobile/cell phone SMS service, which is facilitated by many practice management software packages.

Whilst collecting the patient’s name and telephone contact details is necessary, it is ideal to also collect their date of birth, which assists with the identification of the patient when they eventually arrive at the practice and even with the patient flow if pretesting processes vary for patients of different age groups. It is ideal to also gather the name of a parent or guardian in the case of booking an appointment for a child or adult requiring guardianship. This makes the first presentation of the patient and their parent or guardian a more welcoming experience. Finally, it is also ideal to collect an email address. This allows for additional information to be sent to the patient to introduce them to the practice – for example, a map to find the practice, guidance on travel and/or car parking and information on services and fees. Collecting an email address also permits an additional contact method to confirm the appointment prior to the booking date, if telephone contact proves unsuccessful.

Patient Arrival Into the Practice

The patient should be immediately greeted and attended to on arrival. In the frequent case of practice staff being otherwise busy with a phone call or another patient, a simple acknowledgement with eye contact can ensure the patient has been recognized.

Practice processes on patient arrival will differ for new versus returning patients. In either case, patient contact details are required. New patients, or patients returning after a significant period – for example 2 years or more – may be provided a questionnaire on their vision, eye health and general health history and visual demands, to assist the ECP in addressing all needs and facilitate an optimized optical dispensing process. This is often termed a ‘welcome to the practice’ form, which serves the purpose of gathering necessary patient identification, contact details and health information, as well as asking questions to lead towards identifying all vision correction and eye health management solutions to serve the patient’s wants and needs.

A ‘welcome to the practice form’ is likely to include the following questions:

• Patient details – full legal name, preferred name, date of birth, gender and parent/guardian name in the case of children, or adults under care or guardianship.

• Patient contact details – physical address, email address and telephone number.

• Health insurance information – for example identification numbers in national health schemes and/or private health insurance membership as relevant to the eventual billing of consultation and product fees.

• Health history information – questions relevant to the general eye care practice, specific to its scope. For example, this may include known allergies and medications taken; any history of general health conditions which affect eye health such as diabetes. If there is a concern of protecting the confidentiality of patient health information, these questions can instead be asked in the verbal case history between ECP and patient.

• Eye history information – the ECP may elect to ask questions that form part of a typical case history. Simple and useful examples could include if the patient currently wears glasses or contact lenses; and if they are interested in wearing contact lenses, which can help to raise the discussion in the consultation room. Further detail is likely best gathered verbally in the case history discussion between ECP and patient, to protect the confidentiality of patient health information.

• Consent section – this may include a question of consent to contact other relevant health practitioners with the patient’s permission in the course of their care; consent to be contacted for marketing purposes or other elements of consent as required by the setting and region of the eye care practice.

The ‘welcome to the practice’ form should ideally be comprehensive but not too long to present a frustrating barrier to the patient and a logistical barrier to patient flow. It is also important to keep in mind that a patient presenting to an ECP practice may have impaired or under-corrected vision such that the print size should be no smaller than the typical print size, and larger if possible. It is useful for a practice staff member to check back with a patient filling out a ‘welcome to the practice’ form to ascertain any difficulties and provide assistance if needed. This ensures the patient has an experience supportive of their needs from their initial moments in the practice.

The ‘welcome to the practice’ form could be provided to the patient on their arrival into the practice as a hand-written paper form; an electronic form on a mobile tablet such as an iPad; or even emailed to the patient prior to their appointment with facility for simple completion and electronic return to the practice. Due to the pertinence to the examination process and also the requirement to keep this information on file, especially if a signature of informed consent has been recorded, frequently a hand-written paper form works most easily to be filled out by the patient, handed to the ECP, and then subsequently scanned onto the patient’s electronic record file. Completion at the time of arrival, whether by paper or electronic means, allows for optimized workflow and ensures the patient does not overlook providing the information in the case of a pre-emailed form. Completion within the practice also ensures the maintenance of information security of health information.

If the practice process includes some pre-ECP examination diagnostic testing – for example retinal imaging – then the patient should be informed of this and the process is undertaken as soon as possible.

Handover From Practice Staff to the Eye Care Practitioner

During initial interaction with the patient on arrival, pertinent information on the patient’s intent for the eye examination, and specific questions, may be discussed. This is increasingly likely as the practice staff member spends more time with the patient, for example in undertaking diagnostic testing. The handover process from practice staff to ECP should allow the opportunity for this information to be passed to the ECP. This may take place verbally and informally in discussion between the ECP and practice staff member, and/or formally via written information provided by the patient on a ‘welcome to the practice’ form.

Practice staff may have also had the opportunity to discuss the patient’s current spectacle or contact lens correction, including any limitations or issues; and/or to have selected new spectacle frames pending the outcome of the eye examination. Communicating this information is vital to meet patient needs and to ensure opportunities for optical dispensing are identified. Finally, practice staff undertaking diagnostic pretesting may have specific information on the outcomes or limitations of the pretesting to highlight with the ECP prior to the eye examination. This ensures the ECP has the best possible clinical data available and can identify where additional diagnostic testing may be required either before or after the ECP’s time with the patient in the consultation room.

Handover From the Eye Care Practitioner to the Practice Staff

After the eye examination has been completed, an ECP will typically have identified several measures for the management of the vision and eye health of the patient. The ECP will also have determined when the patient should next return for follow-up or routine care. Collaboration between the ECP and practice staff is imperative to ensure that these recommendations and instructions are realized after the examination, and for clinical messaging within the consultation room to be reinforced in the dispensary and/or at the patient’s final interactions before departing the practice.

Dependent on the practice setting and the skill level of the practice staff, the information provided between ECP and practice staff will vary in scope. For example, a handover between an optometrist and a qualified dispensing optician would likely involve technical detail on spectacle or contact lenses to be dispensed, whilst between an ECP and administration staff may comprise information on billing and when to schedule the next appointment. With regard to contact lens practice, clear messaging between the ECP and practice staff member on when the next contact lens appointment is required is imperative. This is especially important for new wearers, where it has been found that 25% of lens wear discontinuations (drop-outs) occur within the first month and almost 50% in the first 2 months ( ). Ensuring that the patient adheres to the ECP’s determined follow-up schedule, especially for new wearers, can help to reduce the risk of drop-out. ECPs can facilitate this by explaining when and why the next contact lens appointment is required, and practice staff can support this by booking these short-term appointments on handover to ensure patient commitment to successful and healthy contact lens wear.

Specific to soft disposable contact lens practice, typically ‘trial’ or sample contact lenses are first fitted before the prescription is finalized. It is important to ensure that the patient has the correct type and volume of trial lenses for the interval to the next contact lens appointment. Sometimes the correct trial lenses will need to be ordered after adjustment on initial fitting, and/or additional trial lenses may need to be ordered and delivered to the patient within the initial trial period. In either case, the ECP should communicate this to the practice staff member if they will be ordering the trial lenses. Discussion of the intended process between ECP, practice staff member and the patient can be useful to confirm and clarify the contact lens fitting and follow-up process for the patient and allow the patient to ask any last questions of the ECP before the conclusion of this contact.

Contact Lens Instruction Appointment

The neophyte contact lens wearer must be instructed on how to apply and remove their contact lenses, and appropriately clean and care for them. On average, the time allocated for this should be approximately 45 minutes for a new child wearer (12 years of age or less) and around 30 minutes for teen and adult wearers ( ). Depending on the preferences and ECP available chair time in the practice, this may be undertaken by the ECP or an appropriately qualified or trained practice staff member. The instruction appointment is a crucial time to establish confidence and enthusiasm for contact lens wear in the new wearer, so a clear process should be established to manage and counsel any patient-experienced difficulties with handling or initial discomfort. Consideration of support materials to provide the patient both during and after their instruction appointment includes the provision of information sheets and/or demonstration videos covering:

• How to apply and remove their specific type of lenses?

• How to clean the lenses, lens case and other handling items (e.g. removal plungers for gas-permeable lenses)?

• Other ongoing cleaning processes (e.g. specific protein removal treatments for gas-permeable or planned replacement soft or hybrid lenses).

• How to identify normal adaptation symptoms as distinct from abnormal contact lens complication symptoms and what to do about each?

• A clear process for emergency contact in case of a red, painful eye or vision loss in contact lens wear, including after-hours instruction (e.g. an after-hours emergency number for the practice or direction to another health service where more suitable).

A simple mnemonic for contact lens safety and self-identification of complications is when you wear your contact lenses, your eyes should look good, feel good and see well; and, if in doubt, take them out. The patient should clearly and strongly be encouraged to contact the practice as soon as possible if any of these conditions are not met – if their eyes are red, sore or vision is blurred.

Whilst each of these steps in the patient learning how to handle and manage their contact lenses can be delivered verbally and with demonstration, reinforcement with written or video instruction is advised to support what can be an overwhelming process for a neophyte wearer.