The new year is beginning and with it comes resolutions. I want to put this challenge out there — 2014 will be the year that doctors who treat allergies make a promise of clinical improvement for their patients… and inspire patients to do their own part in fulfilling that promise! The common ground required for this achievement: compliance.
Compliance is an important building block in the success of almost any endeavor. In medicine, it’s the key to reaching maximum therapeutic results. With allergy treatment specifically, patients must be disciplined because their symptoms are sometimes periodic, but to attain the highest level of success possible, allergy immunotherapy requires year ’round application. The struggles here are similar to those with hypertension meds where the overall wellness of the patient depends on their adherence to medication protocols even in the absence of symptoms. Studies show that compliance for allergy injection therapy is in the low 30% in most situations. Allergy drops compliance has been reported to be as high as 90% or as low as 20%. II have been fortunate in my medical practice to attain closer to 90% compliance with my immunotherapy programs and I’ll share what I’ve learned to make this possible for your clinic.
The key to compliance with allergy immunotherapy is motivation. Of course it may be easier to motivate patients at the beginning of treatment if they are diagnosed when the misery of allergies is clear in their mind. The hard part is inspiring them when they are asymptomatic, and then maintaining the course when they are feeling good. I’ve found that there are two important “up-front” times to motivate a patient: 1) At the visit when test results show their specific allergies, whether they be to pollen, dust mites, mold or animal dander. 2) At the point of informed consent. You will clearly have the patient’s attention when they are able to visually confront the allergens that have been causing them to sneeze, wheeze and itch. But to parlay that into successful treatment takes effort by both the patient and your practice. If the patient has positive allergy tests that correlate with clinical symptoms and immunotherapy is being discussed, the informed consent process is a vital opportunity to discuss the keys to successful outcome and motivate my patients to invest their time for long-term success.
Informed consent can be accomplished many ways in medicine. It is possible to unknowingly scare a patient out of a treatment with extensive lists of possible adverse events, but if you emphasize the positives in comparison to the potential negatives then you have an interested patient. Fortunately with allergy drops, the advantages far outweigh the few negatives. As always, the goal is to make the patient an equal partner in the decision-making process.
In discussing informed consent for immunotherapy, I start off with the many advantages. First, immunotherapy is a program that’s directed at the patient’s specific allergens (not a generic mix that all patients get). Second, the goal is to not only decrease their allergy symptoms, but to reverse the disease. Third, I explain that the allergens used are not drugs but elements from the environment (such as pollens) designed to train their bodies to accept their normal surroundings. Fourth, I let my patients know that studies indicate that immunotherapy is safe and effective. I also explain that the process of desensitization to allergies is similar to working out with weights: “in your workouts, it’s best to start at a low weight and gradually build up. Of course, everyone wants to see immediate results, but with time you will — you just have to visualize yourself on the road to getting there.” The final clincher with the allergy drops is convenience. When the patient realizes what they are taking is good for them and easy to use, they feel the responsibility to be an active participant.
I always ask patients, “Do you brush your teeth everyday?” They look at me like I’m crazy; they swear they wouldn’t leave the house or go to sleep without brushing their teeth. Well, I tell them, leave your allergy drops by your toothbrush and you’ll never forget to take them either! My patients who regularly take their allergy drops see significant improvement when pollen seasons hit or when they visit a friend’s home with cats and dogs that they couldn’t tolerate in the past.
In the long term, the true key to successful compliance is the relationship between doctor and patient. Studies show that physicians can significantly increase adherence to treatment protocols through consistent follow-up visits. As much as patients know in the back of their minds that they should stay the course, nothing replaces the impact of checking in with their providers for a reminder that they have a partner in their quest for wellness.
Remember, in Latin, doctor stands for teacher. I take it another step further: as doctors we are our patient’s coaches and need to encourage them in the right direction. My best days in practice are when I see my patient at a follow-up visit during a high pollen day and I ask them what’s bothering them and they answer “Nothing!” We both celebrate!
-Dr. Dean Mitchell