people start off with one pair of orthotics and do not switch them from shoe to shoe, though instructed to do so. During the call they are asked to rate the reduction of their original pain in percentage terms as well as what percentage of the time they are wearing their orthotic. Once they understand that the problem is not with their orthotic but rather a compliance is-sue, they understand that they need to switch their orthot-ics from shoe to shoe to increase compliance and get better results. At the end of their call they are told that they will be called in another year and, if eligible, they will be scheduled for a re-exam and dispensed another pair of orthotics that will increase their compliance by reducing the amount of shoe-to-shoe shifting that they have to do. TO SCHEDULE RE-EXAMINATIONS In my practice, I schedule re-exams upon insurance eligibility for insured patients, and at three-year intervals for uninsured patients. The re-exam assesses the physical condition of the orthotic and the patient’s feet and gait. In my experience, the vast majority of my patients are happy with their orthotics; however, I often find that they are breaking down and need to be replaced, or compliance is an issue. This gives me an opportunity to explain to them the benefits of having another pair, perhaps designed for a different pair of shoes. Multiple pairs of orthotics result in increased compliance, thereby re-sulting in happier patients. DISPENSING ORTHOTICS I always ask my patients to bring their shoes to their dispens-ing appointment so that I can fit the orthotics right into their shoe and make sure they sit into their shoes correctly. At this time, the patient is given the correct break-in instructions and I explain my follow-up program. Patients are told that they will be called in two weeks and then at yearly intervals and that a re-exam will be scheduled upon insurance eligibility. All of my patients are happy to hear that there will be follow-ups and it gives them peace of mind to know that they will be called to make sure that the device is working correctly. It’s common to find that the follow-up calls slightly increase the number of adjustments made to patients’ orthotics, but this is due to the fact that many of these patients may have thrown their orthotics into their closet, thinking they were no good, and would likely not have returned to your clinic, had you not followed up. In other words, if you hadn’t called, you wouldn’t have found yourself adjusting the patient’s orthotics, because the patient never would have told you there was a problem with them in the first place. But when you follow up, the patient is more likely to bring the orthotics in for an adjustment and to be satisfied with your service the final product. IN CONCLUSION Since implementing a follow-up program, I feel more confident about the quality of care I am providing and the quality of orthotics that I am dispensing. My patients are more satisfied and, as a consequence, my returning patient numbers and new referrals have increased. • In Part 2 of this series, Dr. Dziak will discuss The Importance of Proper Record Keeping when dispensing custom orthotics – it will appear in the May issue of Canadian Chiropractor. CANADiAN CHiROPRACTOR | APRIL 2013 • 9 After you’ve dispensed orthotics to your patients, having a follow-up program significantly helps with quality of care and patient satisfaction. something I would have made for them. However, at this point they are used to that style, and like it, so I duplicate what they have. AT YEARLY INTERVALS The second follow-up call should be made at one year post-dispensation and calls should be made once a year after that. Follow-up calls every year post-dispensation serve as a friendly way to maintain contact with the patient as well as to acquire statistical information about the orthotics. During the follow-up call, patients are asked the percentage of the time they are wearing the orthotics and their per cent reduction in pain. Clinical Note As a result of the diligence practised at the two-week post dispensation follow-up calls, it’s rare to get a patient complaint in the yearly follow-up call. However, this serves as a reminder to the patient that they should be wearing their orthotics, and that they have not been into the clinic for a treatment in a long time. Often they end up scheduling an appointment, which is a nice bonus for both of you. If there is a complaint at a yearly follow-up call, it is usu-ally due to compliance issues, meaning that the percentage of the time that the patient is wearing their orthotic is low. Many www.canadianchiropractor.ca
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