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Survey: Patients commonly withhold information from doctors

Majority of respondents did not share “at least one type of information” with their physicians.

By Robert Stoneback, associate editor

An online survey of 4,510 U.S. adults found that a majority avoided disclosing at least some medical information to their clinicians.

A total of 3,165 survey participants, or approximately 70%, said that they did not share at least “one type of information,” according to the survey, results of which were published as a study in November in JAMA. The survey included seven categories of information: the amount a patient exercised; whether they understood a physician’s instructions; whether they disagreed with a physician’s recommendation; how healthy or unhealthy their diet was; whether or not they took a specific medication; whether they took prescription medication as instructed; and if they took someone else’s prescription medication.

The survey listed the most commonly withheld information as disagreeing with the clinician’s recommendation (1,703 respondents) and not understanding the clinician’s instructions (1,245 respondents).

“A BIG ISSUE”

Patients withholding information from their physicians “is a big issue and we, as physicians, may not be fully aware how widespread it may be,” says Cynthia Matossian, MD, FACS, founder and medical director for Matossian Eye Associates, in Pennsylvania and New Jersey.

When she feels patients are not being truthful with her, she first relies on body language; she leans in closer, looks them in the eye and says that she’s not going to judge them but she needs to know the truth so she can be sure she’s treating them the right way.

In some cases, an objective test can determine if a patient is using medication as described; examples of this include an omega-3 index test for patients taking fish oil supplements or an MMP-9 test (InflammaDry, Quidel) for dry eye medications. If these test results contradict patients’ stories, Dr. Matossian shares the results and asks if they are taking the medication as intended or if they think it’s a sign of their disease progressing. Patients who are not taking the medicine properly come clean at that point, she says.

VERY SPECIFIC QUESTIONS

Stephanie Becker, MD, of Total Eye Care in Hicksville, N.Y., has encountered her share of patients holding back information, including a LASIK patient who did not share her HIV positive status since she was afraid it would be a contraindication. The trick, she says, is to ask very specific questions. These include, “Did you ever have ANY surgery in your whole life,” “Do you take ANY medicine from a doctor, nurse or therapist for anything,” Did you ever have ANY medical issue or other health issue that required a hospital visit or surgery.”

Why patients don’t tell the whole truth

Here are some of the most common reasons patients have for withholding information from their physician regarding medication use, according to Cynthia Matossian, MD, FACS:

  1. Not understanding medication instructions, or forgetting to use it properly
  2. A language barrier for written instructions
  3. Inability to afford medication
  4. Physical inability to use eyedrops correctly
  5. Language barrier for written instructions
  6. Not using medication due to side effects (blurred vision, burning, stinging, etc.)
  7. Misunderstanding the nature of the disease being treated; therefore, stopping medication use once symptoms have improved, but not fully gone
  8. Embarrassed to tell doctor of improper medication use

Dr. Becker explains to the patients that she asks these questions to ensure that none of their current medicines would conflict with ones they might take following their ophthalmic treatment. These inquires also let her know how well the patient has done with anesthesia in the past.

“I usually try to be very nonthreatening and explain that patients often realize that some over-the-counter and common prescription medicines can impact their eyes — the example of Flomax is one I commonly cite,” she says. Most importantly, she says, the key is to maintain a non-judgmental demeanor.

ONLINE SURVEY PLATFORMS

Participants were recruited using two online survey platforms; after dropping participants for exclusion criteria, 2,011 participants answered using Amazon’s Mechanical Turk (MTurk) from March 16-30, 2015, and 2,499 respondents answered using Survey Sampling International (SSI) from Nov. 6-17, 2015. Researchers conducted data analysis from Sept. 28 to Oct. 8, 2018.

The most common reasons for not following clinician instructions were listed as: not wanting to be judged or lectured (81.8% of MTurk answers, 64.1% of SSI answers); not wanting to hear how harmful their behavior was (75.7% of MTurk answers, 61.1% of SSI answers); and being embarrassed about their behavior (60.9% of MTurk answers, 49.9% of SSI answers). OM

INVELTYS RELEASED TO U.S. MARKETS

Kala Pharmaceuticals has launched Inveltys in the United States, making it the first and only twice-daily ocular corticosteroid to treat postoperative inflammation and pain following ocular surgery available in the country.

Inveltys (loteprednol etabonate ophthalmic suspension) 1% was approved by the FDA in August 2018. It uses Kala’s proprietary drug delivery technology, the Ampplify mucus-penetrating particle, to improve penetration to target tissues.

Kala also hired a specialty ophthalmic sales team of 57 territory sales managers to assist with the Inveltys launch.

QUICK BITS

Allergan has announced positive, three-month topline results for its second pivotal clinical trial of Bimatoprost SR, a biodegradable implant designed to reduce IOP for at least four months in open-angle glaucoma and ocular hypertension patients. In a study of 528 patients with those conditions, the implant reduced IOP by approximately 30% over 12 weeks.

Clearside Biomedical recently submitted a New Drug Application for its Xipere medication, intended to treat macular edema associated with uveitis. If the application is successful, it would be the first FDA-approved therapy for macular edema associated with uveitis. The application follows results from October’s PEACHTREE Phase 3 clinical trial, in which 47% of Xipere patients saw improvement to their BCVA.

Beaver-Visitec International announced an agreement to acquire PhysIOL Group SA, a Belgium-based company specializing in the research, development and manufacture of IOLs. The acquisition, backed by American investment company TPG Capital, is expected to be completed in the first quarter of 2019.

Time to reach AMD patients

AMD Awareness Month begins its fourth year with new ways to engage patients.

By René Luthe, senior editor

It’s February, which means it’s AMD Awareness Month. Rishi P. Singh, MD, Staff Physician, Cole Eye Institute, Cleveland Clinic is participating in the outreach program for the first time this year. The program launched four years ago as a joint venture between B + L and Prevent Blindness.

“I’m a retina specialist, so I have AMD awareness all the time,” Dr Singh says.

That awareness is woefully lacking in the greater population, however, notes Chris Marschall, B + L’s vice president of marketing for Consumer Healthcare Business.

“If you look at the data, more people suffer from AMD than Alzheimer’s,” he says. “But look at how much more awareness there is about Alzheimer’s.”

The company has partnered with Prevent Blindness over the last four years as part of their AMD Awareness initiative to encourage patients to visit an eye-care professional for a fully dilated eye exam.

MAKE USE OF SOCIAL MEDIA

“One of the foremost factors in successfully treating AMD is the timing of entry diagnosis for patients,” Dr. Singh points out. To get that on patients’ radars, he uses social media — Facebook, Instagram and Twitter.

Bausch + Lomb/Prevent Blindness publish posts to their social media pages (facebook.com/bauschandlomb and facebook.com/preventblindness ) about AMD and what patients can do, and your practice can share and leverage these posts.

“In last year’s Awareness Month program, we received about 1 million social media engagements,” says Mr. Marschall. “This means 1 million people liking, sharing, commenting. We felt great about connecting with people and making them aware as well as hearing their stories — people who were suffering with the disease and what they were doing about it.”

B + L kicked off AMD Awareness Month 2019 with the introduction of SightMatters.com .

DON’T OVERLOOK THIS GROUP

As for patients already diagnosed with the disease, Dr. Singh says, they too could often benefit from a little more awareness. “Diagnostics are vastly improved and if we catch this early enough, the patients’ prognosis is hopeful. Treatments are revolutionary compared with what we had before,” he notes. Also, Dr. Singh informs these patients of the clinical trials for upcoming treatments that may help them.

NEW THIS YEAR

B + L/Prevent Blindness have tweaked the outreach every year, striving to reach even more patients. This year, they are unveiling a new website. “If you do an Internet search, there’s not really a definitive source for AMD to go and learn about what they can do,” Mr. Marschall explains. “So, we decided to create it.”

Sightmatters.com launched Feb. 1, offering patients a “one-stop shop” for AMD information. “We’re considering that the gold standard resource for AMD, where people can be informed, create an action plan, learn about new interventions. And they can connect with other people who may be suffering from it too,” says Mr. Marschall.

The hope for the website is that AMD Awareness does not end in February. “With SightMatters, we’re going to try to build awareness in the community.” OM