While clients offer untold excuses as to why they fail to comply with heartworm recommendations and senior screenings, the blame sometimes belongs to the one giving - or not giving - the recommendation.
An often-overlooked barrier to client compliance is the veterinary practice itself, according to the American Animal Hospital Association (AAHA), and much noncompliance occurs because no recommendation is made. These findings and a spate of other compliance shortcomings were highlights from a study on client compliance presented at the recent AAHA conference in Phoenix.
Compliance - defined by AAHA as the sum of the recommendation gap, follow through and client acceptance - directly influences the level of care that practices can afford. "We all strive to provide the best patient care, but it's impossible for practices to accomplish this mission if they do not closely monitor compliance," says Dr. John Albers, AAHA executive director, who spoke at the session.
Dr. Earl Cornprobst admits he's "as bad as anybody else" about providing good recommendations. Although he relies on a semi-annual printout of compliance records for tracking purposes, he says he's now aware of areas, such as dentals and senior screenings, that he should track more closely.
Dr. John Albers
"Compliance depends on the individual staff and is based on the ability of the hospital to market its services. We must educate clients first," he says.
Dr. Richard Coe admits AAHA's findings were "shocking." "I just hope veterinarians return to their offices now, share the findings with others, and check their own records for compliance," he says.
The findings are part of a larger study not yet published by AAHA. As previously reported in the April issue of DVM Newsmagazine, the study explored compliance related to heartworm, dentistry, therapeutic diets, canine and feline core vaccines, senior screening and pre-anesthetic testing.
"Client compliance is definitely not the sexiest subject at this meeting," says Melinda Boehringer, practice manager of Fremont Animal Hospital in California. However, she says her proactive practice has witnessed the payoffs of client compliance. Noting recent figures on vaccines, Boehringer found 85 percent in compliance.
But she credits the client as much as the clinic. "We have an affluent client base, which has an influence. For that reason, compliance is rarely a problem because of financial reasons."
Tallying it up
Medical records from more than 1,400 cats and dogs from 240 practices were gathered to quantify compliance. An additional 1,003 pet owners were surveyed. Key findings include:
- Heartworm. In endemic areas, 83 percent of dogs are in compliance for testing, but only 48 percent comply with preventive recommendations.
- Dentistry. Of dogs and cats with grade 2 or higher dental disease, 35 percent have had a dental prophylactic. Out of the 60 percent of dogs and cats that needed dental work, only 34 percent of clients received recommendations; 17 percent of those followed through.
- Therapeutic diets. Only 19 percent of dogs and 18 percent of cats are in compliance with appropriate therapeutic diets for six specific diagnoses.
- Core vaccines. The area with highest compliance found a whopping 87 percent of dogs and cats are in compliance with veterinarians' recommended vaccine protocols. Changing protocols were factored in.
- Senior screenings. Although no hard data was available, the study found that senior screenings achieved low compliance most likely due to low frequency of recommendations.
Complete results of "The Path to High-Quality Care: Practical Tips for Improving Compliance" will be published this spring and will include a CD-ROM that runs on MS Excel. The software tool will enable practices to measure their protocols and will offer suggestions to alleviate gaps in recommendations and client compliance. The resource set will be available for $10 for AAHA members; $50 for nonmembers. To order, call (800) 883-6301.