Article Date: 2/1/2009

Prepare For Allergy Season
allergy

Prepare For Allergy Season

Here are seven practice-building tips to turn the burden of allergies into a benefit.

BY RICHARD MARK KIRKNER, Phoenixville, Pa.


ILLUSTRATION BY JOHN SCHREINER

Treating ocular allergies isn't just a springtime activity anymore. The onset of pollen season can exacerbate symptoms, but getting your practice and patients ready for the traditional allergy season is becoming a year-round activity for many optometrists. Practice-building strategies can help you plant in patients' minds that you're their go-to doctor for when those spring breezes kick up the pollen and create itchy, watery and red eyes.

So, why should you implement practice-building strategies to prepare for allergy season? Because multitudes of underserved patients need a solution for when the spring and ragweed are in the air. In fact, up to 50 million people have some type of allergy, and 20% of adults have allergic rhinitis, reports the American Academy of Asthma, Allergy and Immunology. Also on any given day, 10,000 children miss school because of allergic rhinitis. Treating all those ocular allergies can be a gateway to building your therapeutic practice, as satisfied patients spread the word about your abilities to treat non-refractive eye problems.

"Clearly ocular allergy is under diagnosed and thus under treated, says Leonard Bielory, M.D., co-director of the immuno-ophthalmology service at the University of Medicine and Dentistry, New Jersey, and a widely published author on the topic. "The typical allergy sufferer is twice as likely to have ocular symptoms than nasal symptoms alone."

The following seven tips should enable you to prepare your practice for these patients, according to your colleagues.

1 Make it a year-round thing

Burt Dubow, O.D., decided years ago to make his practice in St. Cloud, Minn. more medical. "The only way to do that is to do it year-round, not just per season," he says. "If you want patients to think of you as a prescribing doctor, they have to be told that over and over again, on every visit and [in] other ways, so that when the time comes that they need you, they think of you."

In his Douglassville, Pa. practice, Glenn Corbin, O.D., takes a similar tack. "I've transitioned from a seasonal allergy approach to a 360-day-a-year allergy approach," he says. "I write allergy scripts throughout the year because we have patients who have environmental allergies."

For contact lens wearers, spring is when seasonal allergies may overlap with their chronic dry eye problems, says Mary Jo Stiegemeier, O.D., of Cleveland. "With the contact lens patient, you need to be extra vigilant and aware that many patients with seasonal allergies also have year-round allergies, whether it's dust in the house or pets; then additionally they get the whammy of the seasonal allergy," she says.

2 Do a thorough history

Your willingness to treat allergies year-round is futile if your patients don't know you offer the service and if you don't know they have allergic eye problems. This is why a thorough history is important.

In his suburban Denver practice, John Schachet, O.D., includes questions about eye allergies on the patient-intake questionnaire. "Make sure, whether you or your staff take the history, to ask patients about allergies and sinuses, because there is so much spillover with sinus issues and allergy and ocular allergy," he says. "Ask them questions about dry eye, too, because what some people interpret as dry eye is allergy, and what some people interpret as allergy is dry eye."

Patients today are more likely to self-medicate than they were even a decade ago, thanks to the availability of over-the-counter (OTC) allergy medications. That's worth following up on during the history, says Dr. Stiegemeier. "A lot of times if they're [the patient] taking an over-the-counter allergy medication, such as Allegra or Zyrtec, they may not even mention it in their history," she explains. "If I see on their medical form that they take Allegra, I ask, ‘What are you taking the Allegra for? What kind of symptoms do you have?’" (See "OTC Antihistamines And Ocular Side Effects," below.)

OTC Antihistamines And Ocular Side Effects
■ Here are the possible ocular side effects of OTC antihistamines, as listed in Transitions' "Medications and Ocular Side Effects Database." Note that all classes of allergy medications can induce ocular side effects. To view the complete database, which is a comprehensive listing of the ocular side effects of drugs, visit http://en-us.transitions.com/professionals/healthysight/drugdatabase.

You, the O.D., have a responsibility to be "a detective," Dr. Corbin says. He asks every patient about specific [signs] and symptoms. "It's very simple: ‘Do you ever suffer from any redness or tearing of your eyes?’" He everts the lids in every examination. "People often have lid changes that are indicative of allergies, and treating the patient then gives you a reason to bring him back in a few weeks to see whether the lid changes are improving."

3 Let your staff in on it

A key step in building Dr. Dubow's therapeutic practice was educating his staff. " …You can't assume just because we do it in our little exam room that the staff knows what we're doing, so we are constantly educating them about that." This includes his entire staff.

Pharmaceutical representatives can be a valuable resource in providing staff education, Dr. Dubow adds. He has a drug rep conduct training in staff meetings roughly once a month.

The relationship between drug reps and practitioners may have changed with the new PhRMA Code imposed by the Pharmaceutical Research and Manufacturers Association, but they can still visit your office. (See www.phrma.org/files/PhRMA% 20 Marketing%20Code%202008.pdf.) "So even if they [the reps] can't bring lunch, invite them in anyway," Dr. Dubow says. "Your staff needs to hear a different voice telling them that you're the expert. That's important …" he says.

Dr. Dubow explains the logic for having optical staff participate in the training: "What if somebody comes in to have her glasses adjusted and her eye is red and itching? The optical staff has to be well-versed in the fact that we treat that," he says.

4 Use supporting materials

In building his therapeutic practice, Dr. Dubow and his partners printed their home and cell phone numbers on a wallet card for patients. "I say, ‘Keep this handy, and if you ever have a problem with allergies, pink eye, eye injury, call us,’" he says. "‘If it happens on a Saturday, don't wait until Monday. We'll come into the office and see you, and your insurance covers that.’"

He prefers this card to a business card. "They [patients] probably won't carry your business card around in their wallet, but that card they do," Dr. Dubow says. It has proved a fertile source of referrals without frivolous patient calls, he says. "I don't get bothered by people unless it's something serious." The practice also gives first-time patients a larger card than the wallet card with the title, "Red eyes? See us." It lists the eye conditions the practice treats.

In her exam lanes, Dr. Stiegemeier showcases articles about allergies along with photographs of allergic conjunctivitis and giant papillary conjunctivitis. Newly diagnosed allergy patients watch a video for further education.

5 Reach out to other practitioners

When he was starting out in practice, Dr. Schachet met a podiatrist who taught him "take a doctor to lunch day" — one day a week in which the practitioner introduces himself to a medical doctor via a lunch date. That technique helped him get to know OB/gynecologists, general practitioners, internists and allergists. Among the latter, Dr. Schachet met Gary Niemann, M.D., who now practices three days a week in Dr. Schachet's office.

"It has been truly one of the best things we've ever done," Dr. Schachet says. "The referral back and forth with patients is an absolutely natural thing, and it jump starts the allergy season because these people have issues all year-round."

The relationship with Dr. Niemann has boosted Dr. Schachet's dry eye practice as well. "If I had to recommend to anybody the one key thing they could do, it's work on some allergists, and get to know them," he says.

Glenda Secor, O.D., of Huntington Beach, Calif. has an allergist next door in her medical building. "Getting a relationship with an allergist is a real good way to help people beyond just giving them drops or cold compresses, or switching their contact lenses and care products to make them less sensitive," she says. She refers to the allergist her systemic patients; the allergist sends her patients who have eye problems.

Dr. Stiegemeier found a receptive referral source via her local emergency rooms’ triage nurses. "They're the ones who are often making the decisions when the patients' final orders are made up," she says. "A lot of times, the emergency room doctors … tell the patient, ‘go see your ophthalmologist.’"

How do you know which practitioners to approach? "It's not rocket science," Dr. Corbin says. "You know who's good in your community, and you want to send your patients to the best specialist. We ask those doctors to send their business cards to us so we can make the appointments right away."

6 Send letters and call

Follow-up communication nurtures the relationship with other practitioners. "If I refer a patient, I make sure that patient goes with a referral letter, and I expect a referral letter back," Dr. Stiegemeier says. "If I don't get one back, I typically call the office and ask whether my patient came to the office and what was the outcome."

Dr. Dubow underscores that idea. "When you see a patient, communicate back what you've diagnosed, what you've done, or make a phone call back if it's critical," he says. He relays the story of when a general practitioner (GP) sent an urgent referral with a corneal problem that turned out to be herpes. "I called him back that day and told him that was a good pick; it's not common for a GP to pick up [on ocular] herpes. He was pleased that I complimented him."

7 Write, don't sample

Another key to building your allergy practice is to write prescriptions, and be selective about giving out samples. Dr. Dubow gives out samples for the initial treatment to make sure the drug works or on a weekend if the patient can't get to a pharmacy. "Beyond that, we really believe in writing scripts because that's how optometry gets credit for what we do, and that's what real doctors do — write scripts," he says.

Another reason for being selective with samples: "The drug companies are not giving us as many samples anymore," Dr. Dubow says. "They're cutting back."

Before you can write that prescription, however, you must diagnose the allergy — and make your staff and patients aware that you're the one for the job. Follow the aforemenioned seven tips, and you have a great chance of preparing your practice for allergy season. OM

Mr. Kirkner is a medical editor and writer in suburban Philadelphia.


Optometric Management, Issue: February 2009