Simplifying Routines Benefits Patients and the Practice
By Shachar Tauber, MD; Featured in Cataract & Refractive Surgery Today
In late 2018, the surgeons at Mercy Clinic made a commitment to wholesale changes in our perioperative drop regimen for anterior segment surgery, including cataract, cornea, and laser refractive surgery procedures. This change was undertaken because we had been informed by our technicians and nurses that our patients were struggling with issues regarding copays, deductibles, overall cost, and availability, as well as drop compliance due to complexity and confusion.
Further, tales from our call center relayed high patient dissatisfaction with our multidrop branded and generic drop regimens. Staff members were spending hours away from patient care, acting as commodity brokers to help patients access their proper perioperative medications.
We soon found the compounding pharmacy OSRX and its Omni formulations, which combine everything we need into a single drop. The one we chose to employ includes an antibiotic (gatifloxacin 0.5%), a steroid (prednisolone phosphate 1.0%), and an NSAID (bromfenac 0.075%). There is also an option to delete the NSAID component for our LASIK and PRK patients. The drops can be ordered at the time of surgery consultation and are shipped to the patient’s home before the surgery date. The cost is modest—certainly less than any drug coupon programs available.
We sent our pharmacists to visit OSRX’s 503A compounding pharmacy in Montana. (Editor’s note: For more on compounding pharmacies, see “Compounded Therapeutics: Seven Situations When a Closer Look at Compounding Pharmacy Options is Warranted”) They returned feeling that quality, safety, and redundancies were excellent at the facility.
By Christmas 2018, all our patients were receiving their perioperative drops at home to be used t.i.d. for 3 days before surgery and then for 3 weeks postoperatively. Patient satisfaction was markedly improved, and patient call-backs returned to easily manageable numbers. Most important, our staff members loved their Christmas present of being able to spend more time providing direct patient care. They were most grateful to be freed from the frustration of dealing with medication costs and availability issues.
OSRX now has a HIPAA-compliant, secure prescriber portal, which allows prescriptions to be submitted, managed, and tracked online. This feature has increased our level of transparency and control and further reduced patient callbacks.
Additionally, in a bid to help practices reopen effectively with proper social distancing, the company is offering a dilation drop (cyclopentolate 1%/phenylephrine 2.5%) and brimonidine 0.2%. The cyclopentolate-phenylephrine allows patients to dilate themselves before arriving for surgery, expediting the preoperative process and reducing wait times.
The brimonidine can be preemptively dosed postoperatively to mitigate the potential for IOP spikes. Taking this preventive measure, in turn, allows us to perform virtual postoperative day 1 examinations and reduce the number of patient follow-up visits. The cost of these medications is nominal (cyclopentolate-phenylephrine, $15 per bottle; brimonidine, $11 per bottle), and they can be shipped directly to your practice or to patients at no added cost.
These changes in our drop regimens are all significant wins, especially now in the post–COVID-19 surgical world.
Shachar Tauber, MD:
- Director of Ophthalmology Research, Cornea and Refractive Surgery, Department of Ophthalmology and Optometry, Mercy Clinic, Springfield, Missouri
- Member, CRST Editorial Advisory Board
- Financial disclosure: Advisory board (OSRX); Shareholder (Eyevance Pharmaceuticals)