How to Help Patients Comply with Compression Treatment

• By Joseph Duffy
• Jul 01, 2011

Compression is an effective treatment for various conditions, such as varicose veins, foot swelling, mild edema, thrombosis, circulation problems from diabetes, and varicosities of varying severities. Compression garments work on a simple premise: They provide support and increased circulation to the affected area. What isn’t so simple, however, is keeping them wrapped around patients.

Simply put, compression treatment is a tight squeeze, which creates significant noncompliance issues with many patients.

“Compliance has always been a big issue for compression garments,” says Claudia Boyle, compression wear specialist and owner of Van Driel’s Medical Support Wear. “I would estimate that it is a factor for almost 100 percent of patients. No one really WANTS to wear compression garments.”

To help patients comply, Boyle points out five main issues that providers need to address: understanding, application, comfort, appearance and price:

Understanding— Compression therapy is a different type of treatment than most others. Patients generally expect their medical needs to be treated with medication and surgery so that the treatment is quick and simple. Compression therapy is more like exercise: It has to be done daily but yields excellent results with no serious side effects.

• Application — Application is probably the biggest compliance issue. Compression stockings are hard to get on and hard to get off, especially if no hands-on instruction is provided.
• Comfort — Some patients find that their compression stockings are uncomfortable to wear and can even cause them pain, especially later in the day.
• Appearance — Compression garments aren’t invisible.
• Price — Good compression stockings are usually not the least expensive ones. Not all private insurance covers the cost, and only a small percentage of patients qualify for Medicare coverage.

“The order of importance of these issue depends largely on age,” says Boyle. “For older patients application is usually the biggest issue. The hard truth is that the older you get the more likely you are to need compression wear. Older patients may not have the reach and strength that are usually required for stocking application.

For younger patients, appearance tops the list. The problem is that while compression stockings are fairly easy to hide under pants and boots in the wintertime, they are not so easy to disguise in warmer weather. And usually the warmer the weather, the more legs tend to swell.”

Understanding what compression garments do is the foundation of the whole therapy, says Boyle. Lack of understanding is never the lone compliance problem, but patients who understand what stockings do and how they work are much more motivated to overcome the other compliance issues to get the health benefits the stockings provide.

So how should a dealer address these compliance issues? Begin by asking questions.

“Most patients walk in your door with a whole list of concerns about wearing compression,” says Boyle. “Finding out what they are before you begin saves a lot of frustration and allows you to help them make a good choice.”

After addressing questions it’s time to educate your patients.

“I have never met new compression wear patients who really understand why they have too wear the stockings, how they work and what they do,” says Boyle. “Explain the physics, benefits and the potential consequences of noncompliance.”

Application issues can often be resolved with one or two of the application aids that are available. These can be divided into three categories: gloves, slides and butlers.

Rubber gloves are often the most effective and least expensive application aid. The grip of the glove allows patient to gradually shift small amounts of the stockings around their foot and up their legs without damaging the material. Encourage patients to purchase the gloves made specifically for this purpose if they are concerned about application, since they have better ‘traction’ than regular household gloves.

Application slides make the patient’s foot more slippery so that the tight ankle portion of the stocking slides around the heel more easily.

Butlers are metal or plastic devices that the patient stretches the stocking around and then pushes the foot through.

Other tips from Boyle:

• Fit is critical. A good fitting stocking should feel good on the leg. Our experience has been that stockings with only a few size options rarely fit anyone well.
• Invest in a line that gives you a good range of size and material choices. You may need to call the prescribing physician to ask to consider allowing for a lower compression. A slightly lower compression worn daily can yield better results than a high compression that sits unused in the dresser drawer.
• Appearance is less of an issue today. There are so many choices in fabric now, from very sheer hosiery for women to beautiful dress socks for men and even compression stockings that look like athletic socks. If your patient cannot work with one of the more attractive types of material encourage them to try wearing their regular socks over the compression stockings.
• Price is an issue that should be addressed up front. Give your patient a range of pricing and explain the difference between a very inexpensive stocking and one that is more costly. Allowing a patient to try both types will usually do far more to help them understand the difference than words alone.

This article originally appeared in the July 2011 issue of HME Business.